Listening has become a “lost art,” as Michael Nichols stated so well in his book The Lost Art of Listening. Society has become so bombarded with daily activities that many people don’t have time to listen or provide the attentive skills they once readily displayed for friends, family, neighbors, and patients. Listening skills carry over to all aspects of our personal and professional lives, and include our interactions with other office personnel, patients, colleagues, and family. Good listening skills might be considered out-of-date, just as hand-written thank-you notes with carefully chosen words on beautiful stationery were once considered simply good manners. Good manners are often placed on the back burner with the rationale that our high-paced life has eliminated the expectation of interpersonal interaction.
John Hutsman, in his book Winners Never Cheat, writes about the lack of graciousness in business and the need for charity, sensitivity, and respect for others. Hutsman writes, “Everyone wants to feel noticed, respected, and valued.” A basic human need is to be heard, understood, and appreciated. Genuine listening means suspending memory, desire, and judgment, and - for a few moments at least - existing for the other person.
Almost every day I receive emails with subject lines such as “Help!” “Desperate!” “Need Help Now!” I am the co-director of The International Oral Lichen Planus Support Group through Baylor College of Dentistry, a group that began in 1997 with only a few patients who contacted us through email with questions. The site began with a trial period, after which time it was decided that there was a need for such a site. Within a few months, we realized that many people were not being heard and that patients needed someone to listen to their concerns, fears, and comments. Today our mailing list has well over 4,000 participants, and we receive emails daily from locations throughout the world. Educators, practitioners, and family members email the site in search of answers related to lichen planus, with the majority coming from patients. Sometimes people seek practitioners who understand their problems, and often they have questions related to current treatments and medications.
With the aging population and the fact that we will be treating more chronic diseases, the practitioner’s ability to listen becomes even more important and crucial to the well-being of patients. Chronic disease is often difficult for practitioners, because most dentists and dental hygienists prefer closure. Chronic disease states do not fit the “normal” pattern for treatment, and closure is not part of the end product. The satisfaction of a “completed procedure” is often highly valued to those of us in the dental profession.
My dissertation was on the subject of oral lichen planus. It focused on the educational and psychological commonalities of the disorder. While conducting my research and interviewing patients in 1994, I realized the frustrations of patients and the need for listening skills among practitioners. One patient described how she boiled her utensils for years thinking she had a contagious disease. This affected her entire family and her relationship with her husband. After questioning her further, I learned that she had been to a dental office every six months for recall appointments during the five years since her diagnosis. This is more than a little disconcerting. I would like to be able to say that this is a one-time occurrence, but unfortunately that’s not the case. The stories continue in my daily emails, and it is astounding how many patients have not had the communication they need for chronic disease states. As dental offices incorporate new technologies, the dollar costs of new computers and equipment pale compared to the increasing value of focusing on patients. Have we forgotten how to listen?
Most of my listening is done through email and by phone. During active listening we must be able to detach from our own needs and be there for the other person. With hectic schedules and the drive to stay on schedule, there is often little time to stop and listen to other people. In his book The Eighth Habit, Stephen Covey speaks about the importance of empathy and the need to understand the other person before making decisions. Albert Mehrabian developed an empathy scale that defines emotional empathy as, “One’s vicarious experience of another’s emotional experiences - feeling what the other person feels.” Hearing becomes listening when we are able to empathize with a person. We know that job satisfaction is part of a healthy lifestyle and that many dentists and hygienists become disillusioned and ask, “Is this all there is?” Perhaps health-care providers would experience a higher level of job satisfaction if they actively listened to patients and provided them with needed educational materials. Health and life satisfaction can be expanded through knowing that you are instrumental in the happiness and well-being of others. This carries over to the dental practice when exceptional working relationships are established and the environment is one of harmony.
Exactly what is listening? In their book, Effective Listening Skills, Dennis Kratz and Abby Kratz define listening as, “The act by which we make sense of sounds.” They report that as much as 90 percent of our working day involves four modes of communication: writing, reading, speaking, and listening. Interestingly, as much as 70 percent of a day is spent listening to others in the form of mass communication, telephone calls, or active conversations. Some listening occurs without our awareness that we are even listening.
Key points
Some other key points in listening skills are:
• Using “I” statements such as “I feel that” or “I believe that” let the person know what we are thinking. These also direct the focus on us and do not cast any blame on the other person. “You” statements promote a sense of blame, such as “You make me feel like …,” and this can cause a defensive attitude by the person being accused.
• Strokes are important to basic human needs, and some people are better at using strokes than others. The use of strokes lets the person know that you value his or her attributes. Strokes are very important when they are genuine but should not be used unless they are truly appropriate and sincere.
Health benefits
We know that there are health benefits to positive feelings and emotional well-being. We know that every cell in the body is connected, and that cells communicate with each other. Our emotions constantly affect our well-being. The emotional state of patients has a big impact on their health. It is crucial to take into account the total well-being of patients mentally, physically, and emotionally. From an oral medicine perspective, we may be the first person to hear and piece together key information on a disease state that has yet to be diagnosed. This may be the first step to treatment and recovery since many disorders are first seen orally.
I have a great concern that not only is listening becoming obsolete, but I question whether it is being instilled in our younger generations. These generations include not only newly educated dental personnel, but also our children. To develop listening skills, one needs to have someone listening. In other words, we need role models. Our self-worth and ability to relate to others are developed as we mature, and listening skills affect us both professionally and personally. Success has many definitions, but some skills are undeniable in denoting success in life. I believe listening is one of them.
A quote by Fred Rogers in Life’s Journeys according to Mister Rogers: Things to Remember Along the Way sums up listening in a simple and profound way:
“I need thinking time when someone asks me a searching question. I wonder why it seems to be so uncomfortable for many people to wait through the silence. People of all ages have deep feelings, and if we have patience to wait through the silence, it’s often astounding what people will tell us.”
Is anyone out there still listening?
References
• Alessandra T, Hunsaker P. Communicating at work. Simon & Schuster, N.Y., 1993.
• Bosma H, Marmot MG, Hemingway H, Nicholson AC, Brunner E, Stansfeld SA. Low job control and risk of coronary heart disease in Whitehall ll (prospective cohort) study. BMJ 1997; 314:558-65.
• Chambers DW, Abrams RG. Dental communication. Appleton-Century-Crofts. Norwalk, Conn., 1986.
• Covey SR. The 8th habit. Free Press. New York, 2004.
• Epel ES, Blackburn EH, Lin Jue, Dhabhar FS, Adler NE, Morrow JD, Cawthon RM. Accelerated telomere shortening in response to life stress. PNAS Dec. 2004; 101:49.
• Huntsman JM. Winners never cheat. Everyday values we learned as children (but may have forgotten). Wharton School of Publishing. Upper Saddle River, N.J., 2005.
• Kratz DM, Kratz AR. Effective listening skills. McGraw-Hill, Boston, 1995.
• Jampolsky GG, Cirincione DV. Change your mind: change your life. Barnes & Noble, N.Y.,1993.
• McKay M, Davis M, Fanning P. How to communicate. Barnes & Noble, N.Y., 1995.
• Merhabian A. Manual for the balanced emotional empathy scale (BEES), Available from Albert Mehrabian, 1130 Alta Mesa Road, Monterey, Calif. 93940, 1996.
• Nichols MP. The lost art of listening. The Guilford Press. N.Y., 1995.
• Rogers F. Life’s journeys according to Mr. Rogers: things to remember along the way. Hyperion, N.Y., 2005.
• Vella J. Learning to listen and learning to teach. The power of dialogue in educating adults. Jossey-Bass Inc., San Francisco, 1997.
The key elements of good listening are attending skills, following skills, and reflecting skills:
Attending skills
How do you know someone is listening to you? Several key factors demonstrate good listening:
• Appropriate posture is important. The posture of involvement says the person is showing interest in what you are saying. A comfortable social distance is also important in casual/professional conversation. In most social situations this is 2.5 to three feet, and less for personal situations.
• The person uses appropriate body language such as a nod and leans toward you. In direct communication, much of what we say is non-verbal.
• The person shows interest by keeping comfortable eye contact. The person may even gaze at the cheek rather than holding prolonged eye contact since this can be intimidating, especially is some cultures.
• During listening sessions, the person chooses a nondistracting environment that makes the conversation less threatening.
Following skills
How do you know someone is listening to you?
• The person uses “door openers” such as “Tell me what is on your mind.”
• The person uses “continuers” such as “Please tell me more,” or “Please go on,” or “Yes, I see.”
• The person does not interrupt frequently and does not try to share his or her own experiences. In genuine listening, giving advice is not optimal. Most of the time the listener is somewhat like a mirror to the speaker, reflecting back and clarifying the speaker’s thoughts and emotions.
• The person listens with attentive silence.
• The person asks open-ended questions in order to continue following the thoughts that are expressed by the speaker.
Reflecting skills
How do you know that someone is listening to you?
• The person paraphrases what you have said and repeats your thoughts in similar words in order to understand what has been said.
• The person reflects your basic emotions back such as “You sound very worried,” or “I detect fear in your voice.” The perceptive listener can discern the basic emotions of the speaker and refrain from judgment.
• The person reflects the meaning back to the speaker. Sometimes what we think we have heard is not what the speaker meant, so clarification is important. This gives the other person a chance to add new meaning and explanation to what he or she said. This key element of listening is often a problem for health-care providers because we think that we know all the answers before the person has even finished sharing their concerns.
