Learning to Listen
There are many important lessons to learn in medical school. Of course there is the science of physiology and pathology. There is the nuance to taking histories and performing physical exams. We have even been given lectures on cultural awareness. But some lessons are not spoken. Some lessons are more or less subliminal, and if you pick them up it will change not only how patients see you but how you interact with the world.
One such lesson is listening.
Last night I met two wonderful women who sat next to me on a plane trip. One was almost 40, with two kids. The other was young and in her 20s. We talked of work, life, goals and relationships. Eventually the 20-something left for the bathroom and the mother and I were left alone.
She entered into a cathartic rant of all that she has been through in the last few years. A divorce from an alcoholic husband. Entering her kids into counseling over the ordeal. Trying to balance being a mom and working while her company sent her around the U.S. I listened, taking in all that she said without judgement or thought. I just listened. When she was done I offered no advice. I merely made myself present in the moment, offering what little comfort I could. Then the 20-something returned and the moment was over.
This might seem unusual. But for me it is not. The more I learn to deal with patients the more people seems to seek me out. I have been told I “give off a vibe.” Whether that is true or not, I do think people pick up on how well you listen. They can see in your face and body language when you are disinterested or when you are being judgmental. They know when someone hijacks the conversation or seems weary to tread into certain conversational waters. For that reason I have been trying to practice my conversational and listening skills.
As you can imagine from this blog, I love to give advice. But I have been learning lately that advice is not always appropriate, so I withhold it in personal matters unless it is asked for. I have practiced my poker face for when patients tell me shocking or surprising things. The surveys we give when doing HIV tests really helped develop that skill (I have heard about sexual acts you have yet to imagine). I have also started learning how to properly comfort and offer empathy, attempting to stay away from clichés and bland responses.
For us, these things were not explicitly taught. But if you plan to truly be an exceptional doctor, they are things you should learn.
I think that woman on the plane just needed to talk. I was someone she could rant to and never see again. That was fine, I was happy she could get that out. As this happens over and over, strangers sharing personal parts of themselves, I feel very privileged to have their trust. I also feel like it gives me the ability to develop those listening skills that I will rely on in my practice.
You can’t heal a patient without truly listening to their concerns. That is where the art and science of medicine meet.
Hear today, gone tomorrow
The cochlea is the working part of the inner ear, a tiny spiral-shaped cavity filled with a watery liquid called perilymph and lined with a strip of sensory tissue known as the organ of Corti (colored red in this image of a cochlea produced by M’hamed Grati and Bechara Kachar at the National Institute on Deafness and other Communication Disorders).
The organ of Corti itself is lined with rows of auditory hair cells. As sound waves move deep into the ear (outer to middle to inner), they cause vibrations in the perilymph. Thousands of hair cells sense the liquid motion through projecting bundles of hairlike cilia. The hair cells convert the cilia motion into electrical signals that are transmitted to primary auditory neurons, which in turn transform the signals into electrochemical impulses dispatched to the brain for further translation and interpretation.
In other words, we hear something.
It’s a remarkably fast – almost simultaneous – process and understandably delicate.
The three tiniest bones in the human body – the malleus, incus and stapes (Latin for hammer, anvil and stirrup, a reference to their respective shapes) – are all part of the auditory mechanism of the middle ear. The stapes is the smallest of all, just 3.5 millimeters in length – less than the thickness of two nickels.
With age, hearing acuity naturally diminishes, but excessive exposure to noise or overly loud sounds can speed the process by damaging the fragile cilia. The problem has become particularly worrisome among teens, particularly with the advent of devices like the MP3 player and iPod and the widespread use of earbuds, which channel more, louder sound deeper into the ear.
According to a 2010 study published in the Journal of the American Medical Association, adolescents are experiencing significantly greater hearing loss since the early 1990s: 1 in 5 teens may now suffer from impaired hearing.
The question is: Which is more powerful, your eyes or your ears? Watch this clip and experience “The McGurk Effect.” Your ears will feel ashamed.”