Listening

“You seem upset that we did surgery on the wrong side of your body.”

Reflective listening. They taught us about this in medical school. It was in our history and physical exam course. We were specifically taught how to handle an upset patient. The technique was to reflect back what they were saying to you. You were to do this even if you couldn’t provide an answer to what they were saying.

“You seem upset that your surgery was delayed.”

“You seem upset that your son is not doing well.”

 “You seem upset that you had the wrong leg amputated.”

It seemed ridiculous to me. We had to practice it on each other.  They gave us all sorts of goofy scenarios to emphasize the technique like that. We all thought it was a bit ridiculous, but we followed the protocol and learned it. 

Oddly – it works. 

Even with someone who is very very upset, reflecting back their concern can calm them and help the dialogue to go forward.  It has been an invaluable tool through the years. In retrospect that was probably one of the most valuable classes that I had in medical school.

Why?

We need to listen to others. On the other side of it, all of us need to know that we have been heard.

I confess that I am not perfect at this. It is so easy to talk to get my points out rather than actually listening to what other people are saying. And when I do this the conversation can go in circles. Each of us keeps repeating the same thing hoping to be heard. The conversation can get louder and louder and more and more jumbled. 

If I would stop and just intentionally acknowledge what you are saying it would go a long way to improving our communication.  I am frankly pleased that I have a little bit of a reputation for using some of these phrases.  “What I hear you saying is…”

I have found reflective listening to be very effective in working with patients. I have found it to be even more important in meeting settings. 

In an ideal world, every person at the meeting has a purpose for being there. This means that they bring some special training or purpose or value to the meeting. Every person deserves to be listened to. More than that – they really deserve to be heard. If we as a group do not hear them, we have robbed ourselves of the perspective and value that they might bring to the conversation. And often the most junior person might just bring the fresh perspective that helps the rest of us see through the cloud of confusion to what is really going on or what really needs to happen.

That is reflective listening. But there is another lesson that sticks in my mind.

We had a controversial issue during my training as a flight surgeon in the United States Navy. Eventually it came to a special board of flight surgeons (SBFS) to make a decision. This was where the data was presented to all the flight surgeons present in the area and they could then all vote on what was appropriate. The idea is that in the setting of unclear issues, we fall back to expert opinion, and the more experts you can have, the better the decision.

In this case however, the commanding officer interjected a comment. It had wisdom in it. He said of one person presenting, “This doctor is my expert in this area. I either need to trust him and listen to him or fire him.”

That was a fascinating example of empowerment. Suddenly the specialist was being heard. More than that, the specialist felt the burden and duty of his position. He was being asked to have a real impact on the decision making for the entire group. There was an immense weight put upon him. It was an appropriate weight however. He was indeed the expert. His opinion in the matter should really matter. And he should feel and shoulder that responsibility. He shifted from just telling his opinion and “washing his hands” to helping us all struggle with the decision. When he spoke, it was with a much different “gravitas” than it would have been had the commanding officer not empowered him in such a way.

Of course, not everyone is correct. Even specialists can be wrong sometimes. And this does not mean that the rest of us can abdicate our judgement or our conscience. But if we have someone who is supposed to be bringing a special view on something, we had better really listen to them, or we had better “fire” them.

I would call this, “empowered listening.” We really ought to do this more often.If we fail in this people can keep their opinions at a superficial and frankly not very helpful level. But if we truly empower them, then they are pushed to a much greater depth. What they say suddenly has more intensity and meaning. 

I do think there is one even deeper level however.“Fools find no pleasure in understanding but delight in airing their own opinions.” “The heart of the discerning acquires knowledge, for the ears of the wise seek it out.”^[1]

This is a lesson that I learned from my college roommate John. He may not even know that he taught me this.^[2]I was the one that always wanted to talk. We would come away from talking with someone else and I would discover that John had learned more than me. He had been listening more deeply to the person we had been with. He taught me by example some very valuable lessons. I will call these lessons collectively, “Treasured listening.”

1. Go into each conversation hopingto be surprised.If someone says something that does not fit, you might just have discovered an area where you might actually learn. That is a golden and precious opportunity. Do not lose it.Push it forward. Reflect back what they say if need be. Ask more questions. Like pursuing a nugget of gold under the water, go after it. Grab a handful of the sand if need be and sort through it hoping to find the precious within it.
2. Assume that everyone brings a little different perspective. Value that difference and celebrate it. Push yourself to learn from it. That is another opportunity to grow and be changed. No one likes a movie in which you can predict the entire plot and ending. Look for how people think differently. Try to put on their perspective as you might try on their jacket or their gloves. See what it feels like. We seem to all assume that others think like us. They do not. Even though they might be similar in their thinking, there are always subtle differences. Look for them. Celebrate them. Try them on. In so doing you can really learn. I tried this with John’s Dad one day. He told of his profound disappointment in not being medically qualified to fight in WWII. This has stuck with me. It made me realize how wildly different the times were then. Everyone really wanted to go and fight. They were ready to be put into harm’s way. That conversation taught me that tomorrow we all might see things completely different than today. September 11, 2001 was a classic example. In an instant many of us changed how we thought. Tomorrow might bring an event into our lives that will change our thinking again. We can learn today from other’s experiences if we are just wise enough to truly look for it, celebrate it, and listen to it.
3. Value other people.It amazes me the number of times that I go into a conversation and all I really care about is what I am going to say. I walk away empty from those conversations. Everyone has value in the eyes of God. They were created in His image and as such I should value them. I am a fool if I do not push myself to give everyone value. I squander the opportunity of knowing them.If I do this, I walk away emptier. But if I truly value them, I can grow and have a rich experience of them. It does not matter how young or old, rich or poor, educated or uneducated. People all have value. I remember one older patient. He was slow of speech. I wanted to rush in and rush out. I wanted to assume he had little to contribute. It was only because he reminded me of a family friend that I slowed down. I sat down. I listened. And I was richly rewarded. He was in there. He was not only in there, but he carried the wisdom of his age. He was mostly alone because most of us where moving just too fast to notice. But for the wise person who would sit down and slow down and listen, there were precious jewels of wisdom. 

Reflective listening:Bounce back what you hear people saying so that they can know that you heard them. This is powerful.

Empowered listening:Let people, or even make people, take responsibility for their position and training.

Treasured listening: People are a treasure. You can learn and grow each other from every conversation if you are willing to work at it. Look for surprises. Find the difference in their perspective. Value them. If you do this, you will be richly rewarded.

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^[1]Proverbs 18:2, 18:15 (NIV)

^[2]Thank you John!