Listening

Earlier this month, David Brooks, a NY Times columnist, published a truly inspiring op-ed piece, Nine Nonobvious Ways to Have Deeper Conversations (https://www.nytimes.com/2020/11/19/opinion/nine-nonobvious-ways-to-have-deeper-conversations.html). As I read through this short piece, I was again reminded that the work we do as clinicians and educators often comes down to listening – listening to others and to oneself in a deep, undistracted, caring and compassionate way. He frames his article as a preparation for family gatherings – now mostly virtual – for this extraordinarily poignant holiday season, but its implications extend much further.

Most of what we do in the name of listening is hardly that. Stephen Covey, author of the bestselling Seven Habits of Highly Effective People, said, “Most people do not listen with the intent to understand; they listen with the intent to reply.”(1) Think about the conversations you had with colleagues, friends and family over the past few days. At what point during the time that another person was talking had you already formulated your response? Did you even hear the end of the sentence? Did your need to express yourself override your curiosity about their experience? What might have happened had you listened until the end, allowed some silence, then responded in a way that was connected, true and – as Brooks says – “elevating” so that the conversation led to things that matter most to each of us? Brooks continues, saying that we should treat attention as if it were all-or-nothing, and our efforts should be to bring ourselves back to the exhilaration of total focus, over and over again. He likens conversations to  being a midwife – helping the other give birth to the best of who they can possibly be.

Listening is not just about the voices of others, it’s also about listening and honoring your own voice and the places from which those voices emanate. It is hard to say which must come first – listening to self or listening to others. I believe that they inform each other. When listening to others, you become aware of the internal dialogues, and, then, you have a choice as to where to place your attention. When alone, you may come to appreciate the sources of the thoughts that you thought were only your own, and that even what you might call your mind, your thoughts, and your experience is shared with others in ways that neuroscientists and psychologists are only beginning to understand.(2,3) We are social creatures, and this pandemic has brought into sharp relief what it takes to be socially connected and what those connections mean to us. Even when subjected to the brutalities of physical distance, we have learned to smile with our eyes and even experience intimacy over zoom.

Brooks also talks about silence, not to fear the pause. I would go further. We need to find the pause, those ubiquitous moments between the systoles and diastoles of our day, when, in the psychologist Rollo May’s words, we can “throw our weight” toward that which gives us freedom, self-awareness and consciousness. Brooks suggests that we should approach one another with awe, recognizing that each human has unique gifts that can be revealed simply by listening. Internist Faith Fitzgerald would ask residents in morning report to present their most boring patient, and it was incumbent on her to find something truly interesting and unique about each one.(4) What if we took just a few seconds out of a busy clinical visit to discover that uniqueness? How might that change your day? Your feelings about the challenges you face in the workplace? Perhaps your ability to individualize that person’s care?

This is not all about being serious. Jokes, humor, irony and paradox are what you find if you listen, because those too are part of the human condition. Perhaps consider a small exercise – for the first 90 seconds of each patient encounter, and perhaps every encounter with a colleague, spend the time just listening, being curious, with focused attention on the other and the relational space between you. Note how you feel at the end of that encounter, and at the end of the day.

Listening isn’t always easy, though, for the same reasons that it is incredibly gratifying. When listening to others, you find out things that you least expected, things that might even irreversibly transform your image of the other. It takes a particular kind of preparation – preparing to be unprepared, to be surprised, to have a light touch and to be able to laugh at oneself. And the same goes for listening to yourself – just by virtue of listening, you change.

1. Covey SR. The Seven Habits of Highly Effective People. New York: Fireside; 1993.
2. Chatel-Goldman J, Schwartz JL, Jutten C, Congedo M. Non-local mind from the perspective of social cognition. Frontiers in Human Neuroscience. 2013;7::107.
3. Epstein RM, Street RL, Jr. Shared mind: communication, decision making, and autonomy in serious illness. Ann Fam Med. 2011;9(5):454-461.
4. Fitzgerald FT. Curiosity. Ann Int Med. 1999;130(1):70-72.