OK, so the news is that somebody is noticing this phenomenon, of patients reporting adverse side effects of medications, and basically being ignored. If you’ve been on heavy duty medication before, you know this to be true. Now it’s being researched more carefully?

Why? Because for pharma companies developing drugs, they want data that’s as high quality as possible. Right now all they get is data that’s highly filtered through doctors and nurses.

The net of it is “listen closely and take your patients seriously.” Here’s the article:

http://www.nytimes.com/2010/04/13/health/13seco.html

Paul.

  My good friend Elka Vera told me about this fascinating interview on NPR with Dr. Lisa Sanders, who has written a book about the challenges of medical diagnosis.

The problem seems to be that many physicians, feeling pressed for time, interrupt, to move things along. But the result is that they often don’t come to understand what the real problem is, resulting in more follow-up visits, and even more time. Granted, doctors are balancing many factors–it isn’t easy. Nonetheless for some, the idea of “slow down and listen, in order to speed up” could be in order.

On a related note, a few months ago when I went in to see a specialist at Kaiser, I was astounded when he listened extremely attentively for 5 minutes as I explained exactly what I’d observed. He interjected a few small questions, but really left it up to me to guide. The result was that he heard all I had to say, we got on the same page with the situation, and I was able to really take in his point of view. It was great.

“Having the patient tell the story is thought to be the most efficient way of getting all of this data out. And yet we don’t do it.”

You can read the full transcript of the interview or hear it online.

I’ve put an excerpt of theinterview below:

DAVIES: Wasn’t there a study which actually recorded interviews by physicians and gave us a sense of what the interaction was like?

Dr. SANDERS: Absolutely. There’s actually been two that were a few years apart, and they showed the same thing, which is basically, doctors let patients talk for an average of 20 seconds before they interrupt – sometimes even less. In the most recent study, some doctors let a patient talk for only three seconds before they interrupted. And they interrupted with a very specific question, usually. But the chance that the patient would go back and finish that story is almost zero. I mean, it almost never happens.

They get distracted. New information prompts new questions, and people go on to, you know, describe other symptoms. But having the patient tell the story is thought to be the most efficient way of getting all this data out, and yet we don’t do it.

DAVIES: And do the studies also indicate that when doctors do interrupt, that they get an inaccurate picture of what’s going on with the patient?

Continued on the NPR website.

Underneath the mechanical techniques of listening, there is something much more powerful: the mindset, the set of attitudes, that you bring into a conversation.

If you’re like most people, you don’t go into conversations with a conscious mindset. Rather you leave it to chance, and find that while some interactions go well, otherwise go poorly—and you don’t know why. Because your mindset has a major impact on the conversation, it’s worth paying attention to.

And herein lies the good news: when you consciously bring your best “listening game”, with a great listening mindset, you’ll have a better experience. Here are two of my favorite mindset tips for enjoyable holiday listening.

Mindset #1: Goodwill
There you are, at a holiday party, talking with someone you’ve just met. Sometimes this is a person you take an instant liking to, and sometimes… it isn’t. I have news for you: they can tell. You may think you can hide it, but deep down, they can tell.

So here’s what you can do: leverage the power of mindset to find an authentic “source of goodwill” to bring into the conversation.

If you pause for a moment, you can find something to appreciate about anyone. You don’t have to say it out loud, but you can certainly make a point of noticing it, and using that appreciation to bring goodwill into the interaction.

Here’s an example. Once I was at a party listening to a young woman talk about her plans to start a new venture. I was taken aback by her bravado—while she outwardly claimed that she knew precisely how to make her venture a success, her ideas, experiences, and body language told me otherwise. I briefly considered asking her a tough question, but then thought “heck, it’s the holidays.” Instead I took a deep breath and looked for a point of goodwill.

And a funny thing happened—I found myself drawn towards her enthusiasm, energy, and positive thinking. That made it easy to project goodwill towards her and her efforts. I relaxed, I became more present and I had a new appreciation that wasn’t there a moment before. The resulting conversation was much more uplifting for me, and I think it was for her as well.

Mindset #2: Learning
There is a unique opportunity in really hearing somebody talk about how they see the world. While it sounds obvious, it’s easy to forget this simple fact: we all see the world differently. It takes a stance of humility to realize that there is much to learn from others.

This really hit home for me a few weeks ago when I was at a party talking with a guy who had extremely strong views… on everything. Although I was initially put off by his attitude, I had a niggling sense that there was something there for me to learn. Clearly he had a lot of passion for his work and for his world view.

So rather than walking away, I did something different. I made a conscious effort to channel a learning mindset. I strove to see his ideas from his perspective, without needing to have a debate about what was right. Sure enough, as I got more interested in exploring his ideas, he shared and developed them to a deeper level. I gained several great tidbits about how and why he’s successful in his business, that I wouldn’t have gained otherwise. My learning attitude, combined with his strong opinions, resulted in both of us having a thoroughly enjoyable conversation. What could have been a “pissing match” turned into a valuable learning experience for me.

I find that this attitude of learning, combined with respect, gives me a natural and curious engagement while listening that is good both for me and for the other person. In my experience, when I cultivate this attitude of learning, I’m able to connect with people who I wouldn’t connect with otherwise, and they tell me really interesting things.

A Final Encouragement
OK, so I’ve given you two listening mindsets to try, for the holidays and beyond. Now for the payoff. I’d like to encourage you to put one of these mindset into action in the coming week. 

1. Pick a mindset, goodwill or learning, and write it down somewhere that you’ll see it regularly.
2. Make a point of consciously bringing that mindset into at least one conversation every day.
3. At the end of a week, consider: How did it go?

If you can do this successfully, I believe that you’ll not just be a better listener, but you’ll also build better relationships with those around you.

Let me know how it goes! Post your experiences below, or drop me a line at contactpaul@supportivelistening.org. I always welcome questions, too.

Paul.

Here is a very powerful story about listening, featured in the New York Times. It’s about a retired Japanese policeman who organized a group of people to help prevent suicides at the site of famous sea cliffs in Japan. The main tool that they use? Listening.

I’m convinced that there is great untapped power in the social networks, the friendships, the families in the world to support one another. They just need to know how.

Read the full story in the New York Times–interesting to note the resistance that this guy is facing in some quarters to his efforts. He doesn’t seem intimated, though.

And by the way, if anybody in Japan is interested, we do offer Supportive Listening workshops in Japanese.

In this crazy world, in this rushed and hurried life, stress is ever present. It finds us at different moments of our day: In bed, trying to fall asleep, our head is filled with thoughts of things that need to get done; in the car, we hope that no unexpected delay will occur, since we do not have much time to lose; when meeting our friends, we try to quiet the distracting thoughts that take us away from the conversation. On occasion, we can tell that we are more irritable than we need to be, make careless errors, or feel easily hurt by others. We are stressed, and stress is an inescapable fact of life.

Or is it? Have we come to accept those sleepless nights, the feelings of being rushed, agitated, or easily upset, even though we do not have to? The truth is that there is an incredible resource that is available to us, which can help us feel better and less stressed, a resource that is often ignored and rarely utilized to its full effect. And this resource is – our friends, our family, the people in our lives whom we can about and who care about us.

Today, I would like to encourage you to be selfish – to take the time and share an issue that is on your mind with someone who is close to you. To allow this other person to support you. The simple act of genuinely connecting with another person who cares for us is powerfully balancing and calming.

And when a friend or a family member shares with you an issue that is on their mind, give them the gift of Supportive Listening. Bring your full self to the conversation, listen to them closely, and do your best to understand their experience from their perspective. Hold off on the interpretation, the advice, the “listen to what happened to me” stories – and just check in with them once in a while, to make sure you understand their story. You will be amazed at how easily they talk, at how their seemingly scattered thoughts eventually evolve into a pattern that is meaningful and satisfying not only for you, but also for them. Give the gift of your presence, your complete attention, and your warm regard, and watch this person, who you care about, flourish in the warmth that you bring.

I’m very pleased to announce that I’ll be offering an evening workshop, Master the Tango of Listening, on Thursday, October 8th, 2009, through the Stanford Center for Education and Professional Development.

This 2.5 hour workshop will be designed specifically for nurses, and participants will receive BRN Continuing Education credits.

Here is the intro:

Learn to provide emotional support for distressed patients without getting burned out. You’ll come away with stronger listening skills and a model for healthy caregiver relationships. By applying these skills, you can decrease the Emotional Drain of Listening.

In this interactive dinner program, you’ll learn what causes emotional drain and how to regulate the level of intensity. You will also learn about the “support triangle” and how it can help you navigate stressful interactions.

This program uses exercises and group discussion to give all healthcare professionals specific tools for healthy listening techniques.

For the full workshop description, see page 4 of the Fall 2009 Catalog (PDF format). To register, see the registration form on the middle of the Center’s website.

In July, Eran and I did a series of public workshops at the University of Pennsylvania. Among other things, we were trying out a new and simplified format for the workshop. We had a good turnout on enthusiastic participants, and the new format was well received.

The Penn student newspaper did a piece on the workshop. I appreciate how the journalists wrote a careful and accurate story about the workshop. The article is a nice overview. Check out the Penn article on Supportive Listening.

After years of searching for a place to do Brazilian Jiu Jitsu, last year I finally found one—Peninsula Jiu Jitsu in Foster City. From the minute I walked in the door, I was warmly welcomed. And in the first week, it became very clear that this was a place that emphasized a collaborative approach to learning.

From what I hear, in many gyms the new guys just get “pummeled on,” so to speak, until they either get good enough or they leave. But Peninsula is really different. The more experienced guys take a certain pride in showing the new people how things are done. I think this comes straight from Marco, who founded the gym– it’s learning as a group effort.

And so perhaps it’s no surprise that I’ve found my listening skills to be extremely valuable in this type of a learning environment. Here there are very experienced practitioners who are eager to share their knowledge about the sport and who want to see me improve.

Yet there are a number of ways that I could screw this up. One way is simply by not paying enough attention while they are explaining something to me. What I find is that by giving my full attention to a purple belt who is telling me all about how to “pass the guard” I’m showing him respect and I’m also encouraging him to tell me more.

Another way I could screw it up is by being argumentative about what I’m being told. I could be skeptical in terms of what actually works. Instead, I assume that he’s telling me this for a good reason, I assume that it’s worked for him before, and I get very curious to really understand what’s being explained to me. And again this respect has a magical effect in that the senior guys in the gym who like to explain things are willing to help me out time and time again.

Just today I was working with Eric, who was recently promoted to purple belt, and he was doing a fantastic job of teaching me some of the basics. I realized partway through that I was actually using the WIG in interacting with him. He would explain something for a minute or two, and then I’d repeat back to him what I understood about it. And sometimes I was right on the mark, and sometimes he would further refine what I’d said, so that I really understood the core of it.

I have to admit that I’m just thrilled to see that my work on Supportive Listening is showing results in other areas of my life.

In great Supportive Listening conversations, there is often a special moment that I call “the tipping point of listening.” This is the point in the conversation when the speaker really gets it, that I’m creating space for them to solve the problem, and that I’m just not going to jump in with suggestions. And that’s the point when the speaker’s problem solving energy really gets going. I had a powerful experience around this just the other day.

So there I am doing Supportive Listening for a colleague who wants to talk about a business challenge he’s facing around the topic of “focus.” Our conversation begins, he lays out the details around his challenge with focus, and then he turns to me and says “So Paul, how do I deal with this?”

Now consider how easy it would be for me as a listener to slip into the role of coach and start guiding the conversation, or to slip into the role of consultant, and tell him what to do.

But I’m very clear here that I see the potential for listening to work its magic in helping my colleague discover his own great insights. It’s a possibility that is often not explored, I believe to the detriment of the speaker.

And so with that conviction around the power of listening, I make a conscious decision not to coach, not to consult, but just to listen. I’m there to be a faithful Supportive Listener, thus giving him the space to take the lead.

I count off a few silent breaths, waiting to see if he’s going to continue talking. But he doesn’t and so I recount his challenge with a WIG. But to my brief recounting of what he’s said, he quickly shoots back “OK, so what do I do?!”

Aha, so he’s pressing me to weigh in with an opinion, to put me in the role of problem solver! But I firmly believe in him, that he’s up to this challenge. Plus experience tells me that once I “grab the microphone” and give him even a bit of advice, it’s hard to hand that microphone back to him, and get his problem solving energy going again.

So instead of answering his query, I bounce the question back to him, “Yeah, what DO you do?” And then I wait.

In that moment the shift happens. He takes a deep breath and says “Well I do a lot of things! Let me give you an example…” and then he’s off and running, analyzing his own situation, now that we’ve established that he’s going to be the problem solver. We’ve crossed the tipping point of listening.

And from that point on, it’s quite easy to do Supportive Listening for him. I just pay close attention to what he says, I offer him a WIG when he’s done, and then he thinks of something new and starts talking again. This rhythm opens up new tracks of thinking for him, and he proceeds to identify the key factors that are playing into his issue around “focus.”

Afterward, when I asked him what he’d gotten from our conversation, he said something interesting. Even though he’d been somewhat aware of these factors before, he hadn’t realized how central they were to the challenges he’s been facing.

I am often amazed at how well Supportive Listening works, without guiding or directing, in helping people to get at the heart of their challenge. Thus I’d like to encourage you to explore this less trodden path, of the role of the committed listener. And if you can stay there long enough, you may reach that magical point in the conversation, where the speaker firmly takes the lead and their insights start to flow. This is the tipping point of listening.

Supportive Listening can bring out the beautiful and joyous in people. Although we tend to think about Supportive Listening as something we “do” when others are upset or unhappy, this way of relating to others aims, first and foremost, to help them explore, express, and accept themselves – the good, the bad, and the beautiful.

Many of us are willing to accept the good in us only half-heartedly. I know many people who automatically respond to any compliment directed at them by denying its truth (“no, really, it only looks like I know what I’m doing”), or minimizing their accomplishment (“thanks, yeah, I guess I just got lucky, but I’m sure it won’t go this well next time.”).

Supportive Listening allows people to come into contact with what they see as the bad in themselves, without having to fear that they would lose the warm acceptance of the Supportive Listener. In time, people can come to accept the so-called “bad parts” of their experiences, at first by acknowledging their existence (“I guess I just get really jealous sometimes”), and later by learning to see their experiences in a more multi-faceted way (“come to think of it, I usually feel really jealous only when I’m tired”).

But the crown achievement of Supportive Listening is when people learn to see the beautiful in themselves, or experiences they have had. I recently met someone at a social event, and we had a nice conversation. As our conversation progressed, I naturally fell into a “Supportive Listening mode,” although my new friend did not express any particular distress. Minutes later, I found myself listening to him as he searched for words to describe a life-changing experience he’s had years ago, which he hesitatingly described as “mystical,” during which he felt that he was connected to the whole world around him, and felt a deep peace and calmness.

It was a beautiful story to hear. Supporting him as he reconstructed the experience, fitting it with words and meaning, I felt as though I had helped him in brushing off the dust from a beautiful part of him, which he was now able to appreciate and enjoy more deeply than before.

I encourage You to experiment with offering Supportive Listening even in regular conversations. Put your focus on the other person and on your acceptance of them, be curious and accepting of their experience and their story, and see what happens. You just might experience beauty.