The power of listening

When I think back on the best moments of my career teaching family medicine, the name Élise immediately comes to mind.

Six months before her Certification exams, my colleagues and I were dismayed by her lack of empathy. Some instructors had seen her interrupt her patients’ explanations. Others complained that she didn’t go far enough in uncovering their concerns or that she had trouble structuring her interviews. In our opinion, Élise didn’t have the skills she needed to become a family physician. Despite a good knowledge base, Élise was running the risk of failing her rotation if the situation didn’t improve quickly.

At that time, I supervised students from behind a oneway mirror. After each session, I gave them feedback to help them improve their interview techniques. The first time that I observed Élise, she began the interview without even introducing herself. The patient didn’t have the time to communicate his expectations or to ask questions. Élise was doing all the talking. After making the correct diagnosis, she prescribed the patient medication without explaining the dosage regimen or informing the patient of any potential adverse effects.

After the interview, I told Élise that her performance did not meet the standards. I reviewed patient-centred interview techniques with her. She listened in silence. I went home stunned; I wanted to help Élise to turn the situation around before her final exams, but I didn’t know how. That night, Mr Holland’s Opus was on TV. I was fascinated by one scene in the film where Mr Holland meets Gertrude, a young, awkward clarinettist who dreams of playing in the school orchestra. Mr Holland asks her to play an easy piece. Her mediocre performance on her first try doesn’t discourage him. He asks her to put down her instrument and then they talk about many things. They laugh. She begins to relax. He asks her to play the same piece again, with her eyes closed. Her interpretation is nearly perfect. She leaves, proud of herself, and having earned an important position in the orchestra.

Could I do the same with Élise?

The following week, I called Élise into my office an hour before the clinic. We had a coffee and chatted. She told me that she came from a remote region where I had practised a decade earlier. Recalling the magnificent lakes and rivers, she told me that she loved fishing with her father. I asked her to close her eyes and picture herself in the boat with her father.

“Are you moving?”

“No, I have to stay still.”

“Are you talking?”

“No, my father says that silence is very important to catching fish.”

“Are you catching any fish?”

“Yes, my basket is full.”

“Élise, practising medicine is like fishing. The fish are the patients’ concerns, and they come in the form of physical or psychological symptoms. Your role as a physician is to ask the patient questions in order to catch the fish. To do this, you prepare your tackle. You put the bait on your hook and you cast your line into the water. You let it drop to just the right depth. You wait silently for the fish to bite the hook. Without judgment or threats, you create an atmosphere of trust and you let the patient open up at his own pace.”

After our conversation, I watched Élise interview a patient. After asking the patient for the purpose of the visit, she paused to listen to the answer. She explored each of the patient’s problems. She was able to find out about each of the patient’s concerns while carefully providing care. She was smiling when she came into the supervision room. She told me that she was very proud of herself and had enjoyed meeting the patient and taking his history. After this meeting, Élise was able to overcome the weaknesses that we had observed.

One month after her Certification exams, Élise came to see me.

“Dr Audet, I want to thank you. I earned five superior certificant scores on my exams and it is all thanks to you.”

“Why do you say that?”

“On the day of the exam, I got there an hour early. An instructor stupidly told me to sit in a corner. Instead of stressing about it, I closed my eyes. I was back in the boat, fishing with my father. I silently prepared my tackle. It calmed me. When I went into the five rooms, I caught every one of the patients’ fish.”

At the end of her residency, Élise left to practise in her hometown. I never saw her again, but I often think of her when I teach my students about the power of listening.

• Copyright© the College of Family Physicians of Canada