A Conversation With … Kate Murphy, Author, Journalist, and Expert on Listening Well

When we feel heard, we feel valued. When others slow down, look us in the eye, and pause to ponder what we’ve said instead of hurrying to weigh in while we’re still sharing, we know in those moments that they care about us. Why then do we so seldom return the favor and offer this kindness to others whom we care about? And, as physicians, how can we develop the skills to offer good listening more frequently to the patients whom we care for?

For this answer, I turned to Kate Murphy, a journalist—a professional listener, if you like—whose book, You’re Not Listening: What You’re Missing and Why It Matters [3], shares some of the science behind listening and offers a number of practical suggestions for listening better. Her analogies and solutions get to the heart of many of the barriers between surgeons and the patients we’re trying to listen to. As a contributor to the New York Times, Ms. Murphy has shared that when she interviews celebrities and CEOs, they often seem surprised by her genuine interest in what they have to say, and they soon relax into a more comfortable mode of communicating, as though they’re being cared for. Because they are. Imagine how our patients would feel.

Experienced surgeons know that curing patients isn’t always possible, but helping them try to heal should be. We can seek to engage more consistently with the patients we treat in ways that make them feel cared for, as though they’re the only person in the world. This is good for them. And as I’ve written before, it’s good for us, too [2].

Please join me in a conversation with Kate Murphy, author, journalist, and expert on listening well. Let’s work on this important skill together.

Seth S. Leopold MD: We know some of the reasons we don’t listen to our patients (and others) as well as we should: time constraints, discomfort with strong emotions, short attention spans, to name a few. What else might interfere with our listening?

Kate Murphy: We are conditioned from an early age to be bad listeners. Think about when you were a little kid. You knew you weren’t going to like what was coming if your parents or teachers said, “Listen up!” As a result, people tend to associate listening with admonition or submission. And then, of course, our culture of speaking out, speaking up, and speaking over other people reinforces that idea. Our modern, noisy environments don’t exactly encourage listening, either. The fact is we, as a society, lack both the mindset and the opportunities to develop as listeners.

For doctors, I think listening well can be even more challenging because people come to them for their expert opinions. After all, they are the ones who went to medical school and completed residencies and fellowships in their specialty. The problem is that people do not seek treatment, they seek care. And really, listening is the easiest and most potent way to show you care. Whether it’s your patients, spouse, kids, friends, or colleagues who come to you with a problem, what they want even more than a solution is your understanding and concern about what they are going through. That in itself is a form of healing.

Dr. Leopold: The pressure on surgeons to keep things moving in the office may be an impediment to good listening. How can we make the most of the time we have with our patients?

Ms. Murphy: Being a good listener is about creating a situation where people feel comfortable telling you things. A lot of that has to do with demeanor. The best listeners project openness, patience, and a sincere curiosity to hear the other person’s story. You need to ask the right questions, pick up on little Easter eggs hidden in the conversation, and also detect subtle, nonverbal cues about how the person is feeling or what they may be holding back. I go into detail about how to accomplish this in my book [3]. But listening is a skill, and like any skill, it takes practice. Some may have more natural talent for it, like playing a sport or musical instrument, but we all can, and should, put serious effort into getting better at it. Your effectiveness and happiness depend on it. Good listeners are not only good doctors, they are good human beings.

Dr. Leopold: Unless we listen to our patients’ stories, we can’t identify the therapeutic target we’re aiming for. If someone comes in with a painful joint and can’t do some cherished activity, an operation that rids her of the pain may not be “enough” if she still can’t return to that hobby. If we operate to reduce the risk of a second shoulder dislocation, but the result is shoulder tightness that impairs a quarterback’s ability to throw, that may be a loss rather than a win. How important are the stories behind the patient?

Ms. Murphy: In this way, doctors and journalists are very similar: If we don’t get the story right, we are shoddy practitioners. If I write a gorgeous, lyrical piece that is based on my own past experiences and expediencies rather than interviews of people who know what actually happened and can provide necessary context, it’s a disservice to my readers and a discredit to me. Same thing with a gifted surgeon who performs a flawless operation without really understanding the patient’s history, goals, emotions, and extenuating circumstances.

For surgeons especially, the consequences of not listening well can be severe. It’s the things you miss that result in after-hours calls and repeated office visits, not to mention malpractice claims. I’m sure your readers know better than I do the statistics about medical errors, most of them resulting from not getting the patient’s story right. The great majority of medical diagnoses—between 80% and 90%—are made on the basis of the patient’s story alone [1]. Research suggests patients and doctors disagree about the reason for the visit, or chief complaint, up to 50% of the time [5]. I recall one study [6] where over half of patients interviewed after seeing their doctor had symptoms that they were concerned about, but did not have a chance to describe. The worst mistake a doctor can make is to construct the patient’s story from fragmented, malfunctioning body parts and data from diagnostic tests rather than listening to the patient tell his or her story.

Dr. Leopold: You write about conversational “earplugs” and the stress we experience when we converse with someone who has an opposing view, as well as the need to support (rather than shift) conversations. All of these things feel important as I think about what happens with patients in the office, especially when they’re telling me something that’s hard for me to hear—let’s say they’re disappointed with an operation that I did. How can I overcome those barriers? What should I do when I start to feel squirmy in there?

Ms. Murphy: The first thing to understand is what’s going on when you feel “squirmy.” That’s fear. And it’s something that is triggered in our primitive brain whenever we feel challenged. In the not-too-distant past, our flight/fight/freeze response kicked in over existential threats like lions, tigers, and bears, but today, our biggest worries tend to be social rejection, isolation, and ostracism. When someone disagrees with us, questions our legitimacy, or generally thinks we’re a bad journalist, surgeon, or person, we feel like we’re being chased by a bear. It’s reflexive. And when you feel threatened like that, it’s incredibly hard to listen. You lash out or shut down.

In order to flip off that panic switch, you need to engage in higher-order thinking, which is what listening is. Instead of getting upset or checking out, get curious. Start asking questions and try to see things as the other person sees them. Listening to people and understanding their perspective doesn’t mean you agree with them, it just means you recognize that they have a point of view, and you might have something to learn from it. Understanding is not binary and can always be improved.

Dr. Leopold: Listening is a two-way street, of course, and I know many readers will be wondering this: How can we get our patients to listen to us?

Ms. Murphy: The best communicators, whether addressing a crowd or a single individual, are people who have listened well in the past and continue to listen in the moment. They know their audiences. They front load their speaking with listening. You can’t make yourself compelling, clear, or convincing if you don’t consider who is in front of you. Not everybody has the same interests, motivations, sensibilities, or level of understanding, and not trying to discern and respect those differences is the surest way to bore or aggravate people, or otherwise make them zone out or shut down.

Also, listening is not just something you should do when someone else is talking; it’s also what you should do while you are talking. You should be attuned to your patient while you are conveying information, paying attention to verbal and nonverbal cues as well as the energy in the room to assess whether they are following you. If you aren’t good at that kind of thing, just ask: “Have I lost you?” “Did I overstep?” “What do you think?” “Are you still with me?” “Had enough?” “Make sense?” “Too much?”