Reflection Paper on Effective Listening Skills

Listening is defined, “the act of hearing attentively (Princeton, 2010).” Restated, it takes more than simply hearing communication; listening is an active thought process. It is hearing and concentrating on the verbal as well as the non-verbal. I took the listening quiz (Burley-Allen, 1982). My score was 75. What does this mean? According to Burley-Allen (1982), a score of 75 is average. I think effective listening skills are analogous to the Gestalt style of psychoanalysis. According to Corey (2004), Gestalt therapy is based on the assumption that we are best understood in the context of our environment. The basic goal of Gestalt therapy is to provide a context that will enable individuals to increase their awareness of what they are experiencing and doing. Moment-to-moment awareness of one’s experiencing, together with the almost immediate awareness of one’s blocks to such experiencing, is seen as the goal of this therapy. As a physician, Gestalt therapy does not “use the language of ‘pathology,’ or ‘normal’ and ‘abnormal.’ Instead, individuals are viewed as having the capacity to self-regulate and to develop their dealings with the various environments they encounter throughout life (Corey, 2004).”

Listening is defined, “the act of hearing attentively (Princeton, 2010).” Restated, it takes more than simply hearing communication; listening is an active thought process. It is hearing and concentrating on the verbal as well as the non-verbal. In addition, most of our communication is non-verbal, which includes listening.

What did your score say about your listening skills? Were you surprised by the outcome?

I took the listening quiz (Burley-Allen, 1982). My score was 75. What does this mean? According to Burley-Allen (1982), a score of 75 is average. What does this mean? I do not know because, unfortunately, Burley-Allen omitted the explanation of his four score categories. He did not describe the strengths and weaknesses of each score category. Therefore, this paper will answer the remaining questions from my point of view, instead of Burley-Allen’s. In addition, I will focus the paper as pertaining to my profession of medicine. I believe this will help me become a more effective listener because I will be able to learn from my strengths and weaknesses and apply them accordingly.

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I think effective listening skills are analogous to the Gestalt style of psychoanalysis. According to Corey (2004), Gestalt therapy is based on the assumption that we are best understood in the context of our environment. The basic goal of Gestalt therapy is to provide a context that will enable individuals to increase their awareness of what they are experiencing and doing. Moment-to-moment awareness of one’s experiencing, together with the almost immediate awareness of one’s blocks to such experiencing, is seen as the goal of this therapy. As a physician, Gestalt therapy does not “use the language of ‘pathology,’ or ‘normal’ and ‘abnormal.’ Instead, individuals are viewed as having the capacity to self-regulate and to develop their dealings with the various environments they encounter throughout life (Corey, 2004).” I believe this is an invaluable tool as a physician. Listening to patients explain their symptoms, being aware of their moment-to-moment experience, will facilitate the therapeutic process and even lead to more accurate diagnosis.

What are your strengths and weaknesses when listening to others? How can you improve your listening skills to strengthen your weaknesses? In addition, how can your strengths be utilized and applied to your profession?

The listening quiz does not qualify if a listening habit is considered a strength or weakness. Some individuals will define certain listening strengths as weaknesses and vice versa. For example, habit eight states, “Form a rebuttal in your head while the speaker is talking? (Burley-Allen, 1982).” The score for this habit is one point for “most of the time,” two points for “frequently,” three points for “occasionally,” and four points for “almost never.” In order to score the maximum four points then the answer would be “almost never.” However, I disagree with Burley-Allen’s assumption. I think effective listening is to be engaged in the thought process while the speaker is communicating. This includes forming a “rebuttal in your head while the speaker is talking.” The listener can then adjust the rebuttal accordingly to the speaker’s suggestions. Forming a rebuttal includes concentrating on the communication (habit 5), learning from the speaker (habit 6), recognizing semantics (habit 7), accomplishing communication (habit 17), think about reactions (habit 19), and etcetera. According to Burley-Allen, some of these habits are considered strengths and some are considered weaknesses. Therefore, the listening quiz shows low internal validity.

The primary act that a physician does with a patient is listen. During the first encounter between a physician and patient, the physician will start the communication process by asking, “What brings you in today?” This question is followed by active listening. During this process, the physician tries to understand the patient and assemble a diagnosis. If pieces of an analysis are missing, then the physician will paraphrase the data and ask additional questions in order to narrow the choices. I believe that active listening is the most important act that a physician can do.

In relation to the topics covered thus far, identify at least three techniques that could help you improve your skills.

The three techniques that can help improve my skills are: (1) resist distractions, (2) summarize in my own words, and (3) keep an open mind. The first technique is resisting distractions. The Penguin Dictionary of Psychology (2001) defines stereotype as, “A set of relatively fixed, simplistic overgeneralizations about a group or class of people. Here, negative, unfavorable characteristics are emphasized, although some authorities regard positive but biased and inaccurate beliefs as components of a stereotype.” It is easy for my mind to become distracted while listening to a speaker. I tend to do this frequently. For example, if a patient comes in who looks underprivileged, then I tend to stereotype the patient’s background and struggles. This causes me to ignore important communication from the patient. (Note: It is difficult to resist distractions when a patient has a foul odor and the physician is trying not to vomit.)

The second technique I have identified is summarizing. This is a useful tool when applied correctly. However, I tend to assume to know what the patient means and not summarize in my own words. If I can learn to summarize a patient’s story in my own words, then there will be fewer miscommunications. This will lead to a more productive doctor-patient relationship.

The third technique is to keep an open mind. The Penguin Dictionary of Psychology (2001) defines ethnocentrism as, “The tendency to view one’s own ethnic group and its social standards the basis for evaluative judgment concerning the practices of others, with the implication that one views one’s own standards as superior. Hence, ethnocentrism connotes a habitual disposition to look with disfavor on the practices of alien groups.” I am very judgmental. I consider this habit a strength; Burley-Allen scores it opposite as I do (habit 28). Being judgmental allows the listener to form personal thoughts from the speaker’s message – a gestalt of the communication. Habit 28 did not specify if judging was considered positive or negative, so I give it a positive connotation. Our textbook states, “Try to understand the emotions or interests that may lurk hidden beneath a given complaint or statement. Often the person you’re talking with won’t be fully aware of them themselves (Hattersley & McJannet, 2008).” In the context of ethnocentrism and judging negatively, this can be detrimental to effective listening. For me, this is similar to technique one: resist distractions. I can be a more effective listener if I keep an open mind and not judge negatively about a patient. (Note: It is difficult to keep an open mind if a patient does not have insurance, which is unethical by the physician.)

Why is it important to possess strong listening skills in business and management?

The Website for the California Society for Oriental Medicine reports, “The February 19 issue of the Journal of the American Medical Association published a report by the Agency for Health Care Policy that studied the communication level between primary providers and patients. They found that physicians who listen to their patients and use a friendlier manner during visits might reduce the risk that they will be sued for malpractice. In the randomized controlled study they found that physicians that told their patients what procedure or technique they were doing, or going to do, who elicited opinions and questions from the patient, and were more likely to use humor and laugh, were more often in the group without any malpractice claims. Physicians who spent more time with their patients were also more likely to be in the no claims group (CSOM, 2003).” This is invaluable – including non-monetarily – as a physician. The patient will feel more comfortable and allow the physician to perform examination procedures if the physician first explains the procedure and actively listens to a patient’s opinion and questions. In addition, I think it is essential to allow multicultural or multiethnic patients to construct their own understandings of the therapeutic process and to engage in interpretation and other forms of higher-level functioning. This will further facilitate an active process of listening by the patients.

I believe sacred and confidential communication between physician and patient contain specific phases that can maximize listening efficacy. First, during the initial interview, the physician can begin to establish a collaborative relationship with the patient. It is essential that the interview focus on the patient’s own wishes and goals. Second, the physician should honor the patient’s concerns. It can be easy to respond to the emotional side of patients’ feelings – the pain or need that motivates them to seek help and enter the hospital. The reactive emotions and resistance of patients’ disclosure may be helped through effective listening. Third, physicians need to respond to patient’s questions and suggestions that can only be accomplished through the active listening process. Responding to the patients’ feelings, in an open-ended way, will usually produce the most information and intensify the doctor-patient communication. Finally, termination is an important and distinct phase of medicine that needs to be negotiated thoughtfully. Ending the relationship will almost always be of great significance to patients. It is necessary to listen to a patient’s closing remarks because this usually suggests the overall quality of care. I believe that all of these phases will contribute to a more effective listening and communicating relationship between doctor and patient.

The Penguin Dictionary of Psychology (2001) defines countertransference as “the analyst’s displacement of affect onto the client [and] the analyst’s emotional involvement in the therapeutic interaction.” This means that all feelings, thoughts, or actions of the physician that involve or influence the doctor-patient communication process are countertransference. This definition suggests that countertransference is a destructive element in medicine; however, not all countertransference issues are unconstructive. I believe that through maturity and growth, as a professional, combined with a thorough understanding of his/her ethnicity, values, and biases, can enable a physician to effectively identify and manage countertransference to make it productive. Countertransference is a constant element in interpersonal processes, and I believe it is inevitable in the doctor-patient relationship.

In conclusion, when a physician engages in effective listening, the physician, without sharing it with the patient, has an opportunity to learn something about him or herself and utilize it for his or her personal maturity and professional growth. The physician needs to be aware of his/her own personal assumptions, values, and biases, and understand the worldview of culturally diverse patients to develop appropriate interventions, strategies, and techniques.