Listening as Work in Primary Care

By Cocksedge Simon , Radcliffe Publishing Ltd; , 2005. . PB £21.95 , 175 pp . ISBN 1‐85775‐636‐3

Despite the numerous medical advances as well as the tremendous financial, organizational, and management changes and innovations experienced by the healthcare system in almost all parts of the world, the doctor–patient relationship remains a fundamental, necessary, and critical aspect of care. Indeed, an ideal doctor–patient relationship demands good communication on the part of both doctor and patient, and for the doctor, listening is vital. Consequently, ‘Listening as Work in Primary Care’ comes at a time in which perhaps doctors and all health‐care professionals need to pause and remember what is most important to patient care amidst the technologies and miracles of modern medicine. Listening is a skill that is always required.

Drawing on his experiences as a general practitioner (GP) in Derbyshire, England, the author addresses three questions in this brief and easily read text. They are: (i) How do patients conceptualize listening work in their encounters with patients? (ii) How do GPs manage the effects of this work over time, the cumulative listening that builds relationships? (iii) In everyday general practice, how do doctors frame the limits to their listening, both with patients and for themselves? He accomplishes this through 23 in‐depth interviews with GPs from a semi‐rural area in northern England, applying appropriate qualitative methods. He reports his findings with the use of brief vignettes of stories told by the doctors themselves to illustrate important points. As the Introduction states, the stories ‘offer a narrative window on what actually happens in general practice and in general practitioners’ encounters with their patients’. While this makes the text a quick and enjoyable read, it also points to some major limitations of his work, which the author does acknowledge. That is, these are doctors’ stories about their patients rather than patients’ stories. Moreover, the research which the book and its points discuss is based on findings from one small semi‐rural English community. The reader must clearly take these limitations into account in reading this text and applying its themes to his/her own experience.

Regardless of these limitations, this text seems to transcend its limitations and present themes that are important to doctors and other health‐care providers working in primary care. In fact, it has a fresh quality that causes readers to reflect upon their own experiences and question how they listen to patients, as well as consider the priority they place on ‘listening as work’. Further, the author provides numerous references in each of the 12 chapters that may be used for more in‐depth and even ‘academic’ exploration of this topic if the reader so desires. Moreover, it is clear that while the author presents his qualitative study based on 23 interviews, he also draws heavily from the published literature to connect the stories and provide guidance for the reader on how to make ‘listening as work’ indeed work for the primary care practitioner.

Clearly this is a book for those interested in learning more and enhancing their skills in what Jacobson et al. call ‘‘the art of medicine [which is] founded upon context, anecdote, patient stories of illness, and personal experience; these are classified as ‘lower quality’ in the hierarchy of evidence, but have an equally valid contribution to decision making. … It is this integration of ‘stories’, anecdotes, case histories and evidence that is one of the successes of primary care’’. ¹ In reality, these stories and the subject matter of this text offer what is needed if doctors are ever to become practitioners of what today is referred to as ‘patient‐centred’ care; this book should be essential reading for all medical students and its concepts reinforced in continuing medical education.

In the ‘‘Postscript’’ of this impressive text, the author states what those of us in primary care have known all along. He writes: ‘Although communication skills are required, ‘just listening’ is seen not simply as a set of skills but as a part of ongoing relationship within and across interactions. It is thought to be a legitimate and potentially therapeutic way to use time in primary care interactions, requiring energy from doctors along with skills, which can be improved by training’. In sum, this book is worth reading by all who provide research or are interested in primary care. The lessons taught cut across national and cultural boundaries and make us indebted to the doctors in semi‐rural England who allow us a glimpse into their practices and how they listen to their patients.