Active listening in physician-patient communication and medical interactions

¶ … HR, Communications, Integration Management

Active listening is probably one of the most important skills in the management environment today. Indeed, it is recognized by most businesses as one of the most important components of successful Human Resource management is active listening. Active listening means that there is an active attempt to understand the point-of-view of the speaker at any given time. When such an understanding lacks, questions are asked in an attempt to achieve a better mutual understanding. Promoting active listening also mitigates potential conflict situations in the office.

In the medical profession, active listening means more effective treatment, better mutual understanding between the doctor and patient, and also effective treatment across cultural barriers. This project therefore focuses on this type of listening when physicians interact with their patients. Within this context, the roles of nurses and administrative personnel will also be investigated.

1. Introduction

Active listening is probably one of the most important skills in the management environment today. Indeed, it is recognized by most businesses as one of the most important components of successful Human Resource management is active listening. Active listening means that there is an active attempt to understand the point-of-view of the speaker at any given time. When such an understanding lacks, questions are asked in an attempt to achieve a better mutual understanding. Promoting active listening also mitigates potential conflict situations in the office.

According to Lang, Floyd, and Beine (2000), active listening is particularly important in the medical profession. The authors note that active listening on the part of the physician can help the patient form a better psychological platform on which to build the healing process. What makes this challenging is that patients are not always openly forthcoming in terms of communicating their reasons for physician office visits (Lang, Floyd and Beine, 2000, p. 222).

Another important concern in active listening is culture. If the doctor is of a different culture than the patient, it could be difficult for the latter to be truly honest about his or her condition. Active listening is therefore particularly important in this regard (Ferguson and Candib, 2002). Indeed, the ability of doctors to successfully apply active listening tends to influence not only the doctor-patient relationship when cultures differ, but also the ultimate health outcomes.

To mitigate these concerns, Fassaert et al. (2007) suggest the development of an Active Listening Observation Scale (ALOS). Indeed, the authors suggest that, while doctors appear to focus on the diagnostic element of their relationships with patients, the patients themselves tend to value those who include a personal touch much more highly than those who do not (Fassaert et al., 2007, p. 258). There seems, therefore, to be a discrepancy between the focal points valued by physicians and those that are important to patients. Particularly in cases where there is a condition that patients don't want to reveal initially, active listening will create a much more effective platform for treatment.

This project will therefore focus on ways in which physicians and other medical personnel can determine not only the physical ailments that drive patients to seek medical help, but also the psychological and mental states behind these ailments. Active listening can provide a more accurate platform of diagnosis for physicians, while creating a better experience of care for patients.

3. Project context

The context of the project will focus on physician's offices and hospital environments. The internal environment will focus on the interaction of the physician and patients with each other, where the level of interaction will be measured in terms of successful active listening.

The literature reviews several important areas of potential investigation: the context of serious, life-threatening illness such as cancer and that of minor conditions such as diabetes. In both of these, active listening is important for divergent but related reasons. Furthermore, the context of culture in doctor-patient relationships is important, while the educational context for medical students also increasingly focus on the importance of active listening and its role in effective communication with patients.

The project will be carried out over six months, with the first two or three months focusing on doctors, while the next part of the project will focus more widely on relationships between patients and other types of medical staff, such as nurses and administrative personnel.

4. Stakeholders

There are three groups of stakeholders for this project. Primarily, patients as recipients of medical care are seen as the first group of stakeholders. The interest of this group is to obtain an optimal level of health by means of medication administration by physicians and hospital staff. The interest of this group is in obtaining a mutual understanding with physicians and/or nurses regarding the condition they suffer from and how to mitigate the condition.

The second group of stakeholders is physicians and nurses, who work to deliver medical care to patients, and to determine the best form and extent of such care.

The third group of stakeholders is administrative personnel, especially in hospitals, who determine the best way in which to obtain the appropriate medical and/or psychological help for incoming patients. For this group, active listening may appear less important. However, interpreting the words and expressions of patients accurately could mean the difference between life and death.

5. Organisational Structure

The organizational structure will be considered in terms of the stakeholders, with physicians being at the highest level, commanding medical knowledge and expertise. Nurses will be at the second level, assisting and supporting physicians in their work with patients. Active listening is not less important at this level, as nurses are often at a more personable level with patients at hospitals than head physicians. At the primary level of active listening are administrative personnel, especially at hospitals, who need to direct patients to the correct physicians for their ailments. Administrative personnel at doctors' offices are also important, as these personnel are often engaged in decision-making processes regarding the length of appointments and the care that is needed.

6. Roles, responsibilities and relationships of project team members

The team leader will administer the responsibilities of each team member, as well as collocating the data gathered during interviews. The team leader will also determine the final format and content of the report.

Several roles will cover the various interviews to be conducted. Physicians, nurses, administrators, and patients will be interviewed. Within these groups, the type of illness and cultural context should also be investigated. Where doctors operate in a multi-cultural context, the potential exists to investigate the effectiveness of active listening, or its absence, can be investigated. Furthermore, the effects of active listening in the critical clinical context as opposed to the GP office can also be investigated. Provided that enough team members are available, each will fulfill one of these interview roles. Focusing one role per team member will provide a valuable sense of consistency when interviews are conducted and data compared.

All conductors of interviews will report to the team leader. Each person who conducted interviews will be responsible for transcribing the interviews in question and creating reports that provide the main themes of each interview.

7. Team Development and Conflict

Because teams are made up of human beings, it is likely that conflicts will arise, especially during the beginning stages, when team members are not yet familiar with the procedure, their tasks, and the management setup. The team will need time to develop a proactive approach towards the project at hand, as well as towards finding solutions to problems that may arise. Before the team will function effectively as a unit, however, time will be required for the resolution of interpersonal and team conflicts that may arise.

Glasl and Friedrich (2004, p. 3) define teams as "work groups" that fulfill tasks for which joint cooperation is required. To achieve optimal cooperation and performance, the authors note that there are five levels of team work at which good conditions need to exist. These include: Individual group members; content; interaction; procedure; and external group relations.

At the individual member level, group members each possess specific personalities, perceptions, concepts and ideas, emotions, intentions, and behaviors. These need to be at a relatively stable level for groups to function effectively. Each group member should have intentions and behaviors that at least aim to function well as part of a team. This is also the first level at which conflict might arise, as task allocation and leadership may be perceived as incompatible with individual personalities or aims.

The second level is the content or issue level, where the topic and task to be performed are the focus. This is a more collective level of teamwork, and each team member should be in agreement about the specific task to be performed. Conflict could arise here when all team members are not in agreement or at the same level of understanding with regard to the purpose of the project or the tasks that need to be completed in order to achieve this purpose.

At the third level, interactions at the psychosocial level need to be effective in order to work together as a group. Group members need to have attitudes that are positive both towards each other and the general leadership of the team, as well as to the tasks that are to be performed.

At the procedure or method level, techniques for problem-solving and decision-making need to be in place. This means that internal rules should be in place, according to which team members can make analyses, transcribe data, and make decisions regarding important information to submit for the report.

At the fifth level, the team functions within the context of a certain group. In the case of this study, the external group will be the medical community that is the target of research. In the research, there will necessarily be certain rules and regulations according to which team members should interact with the medical community. These rules and regulations should be disseminated to all team members according to the specific community they will enter, whether this be individual doctors' offices, patients' rooms, or administrative personnel work stations.

Specifically, the doctor-patient relationship should receive the highest degree of respect, and agreements can be drawn up by means of which researchers pledge to maintain the anonymity of patients.

Generally, conflicts that arise would be likely to occur at one of these levels. The team leader should be highly aware of the potential for conflict, especially at the beginning of the work, and maintain an open paradigm of communication with team members. Team members who experience conflict should then be willing to communicate the nature and extent of the problem with the team leader. The team leader, in turn, should identify the nature and level of the conflict, and act as swiftly as possible to obtain a resolution.

The possibility of conflict should be minimized by means of as much communication as possible during the first stages of the work. Team members should make sure that they are aware of all the rules and regulations of their work, while also being aware of the needs of the group and how each role contributes to fulfilling the collective task of the group.

Indeed, the very central topic of the project, which is active listening, can be used as a springboard for interpersonal conflict resolution. Team members can be made aware of the lessons learned regarding active listening and how this can promote mutual understanding among the team members. A sound theoretical basis should be built prior to the practical investigation, which can in turn be used for the purpose of conflict resolution when team members find themselves in disagreement with each other or with their research subjects.

8. Conclusion

Active listening is a vital part of communication. This is particularly so in the case of the medical community, where patients often struggle not only with the physical effects of their illness, but also the psychological difficulties and uncertainties the condition creates. This, in turn, could have an impact on the diagnosis and effective treatment of the condition. Active listening to promote an understanding of a patient's underlying communication could go a long way towards speeding up the process and curbing frustration for both physicians and their clients. Doctors and other medical personnel would therefore do well to create a basis of understanding from which they can work effectively. Research on both serious and minor conditions appear to agree that active listening is more likely to create a holistic conception of the patient's condition than simply applying traditional diagnostic tools (Van Weel et al., 2008).

Importantly, active listening extends not only to the primary condition of the patient, but also his or her overall experience of the therapeutic process. This also extends to the context of culture. An active-listening doctor will have better patient outcomes for cross-cultural cases than a physician who does not engage in this type of listening (Gao et al., 2009). Indeed, this is as important in preliminary screening as it is during and after the therapeutic process.

Furthermore, active listening is a rich field of study, particularly for the medical profession, where it does not only promote the healing process, but could also mean the difference between life and death for a patient.

9. Recommendations

As mentioned by Hoffman, Utley, and Ciccarone (2008) as well as Klemenc-Ketis and Kersnik (2011), this has important implications not only for current physicians and their practice, but also for the training and education of up and coming physicians. Increasingly, it is being recognized that active listening is a vital component of the healing process. Hence, it is recommended that physician training programs be developed for both medical students and existing physicians to enhance their active listening skills. These programs should include a component that indicates the importance of active listening in the therapeutic process.

A further recommendation is that more research be conducted into the effects of active listening, especially in patient outcomes for minority cultures, and in any situation where the physician's culture differs from that of the patient. Furthermore, active listening should be investigated in all areas of the medical profession. This project considered only a limited number of components, including serious, life-threatening conditions, minor conditions, the hospital and GP visitation context, nurses, administrative personnel, and certain cultures. This provides a good platform for further, more in-depth investigations into the benefits of active listening.

Another are of further investigation is also the dangers inherent in active listening. Misinterpretations, for example, could create the danger of serious misdiagnoses and incorrect treatment prescriptions. Although this might not always mean the difference between life and death, it is vitally important that doctors ensure the accuracy of their active listening interpretations, especially where different cultures are concerned. The role of cultural sensitivity training might therefore also benefit from considerable investigation.

In conclusion, the doctor-patient is one of the most important human relationships in terms of promoting health and well-being for the modern human being. For this reason, communication in this profession is one of its most critical components. Active listening forms a vital part of the healing context; at times for both patients and their families. Hence the future investigation of this component in the medical profession is highly important to ensure the longevity and well-being of the human race.