I can’t hear you!

Article published in the 1996 October / November Edition
Words by: Heather Mackenzie-Carey

Consider the following scenario. You are dispatched for a conscious, breathing 45-year-old male patient complaining of chest pain. It’s a cold snowy night and you were on the phone to your “significant other” discussing the weekend plans when the call came in. Your partner is not your regular partner as he is off sick. You are attending so you ask the patient appropriate history questions while your partner gains more information from the patient’s wife.  En route you provide appropriate treatment procedures according to the information you received. As you are transferring your patient over to the hospital staff and reporting the history, the patient suddenly interrupts you and reports he does have chest pain at the moment, and he does have a history of congestive heart failure. You leave the emergency department   frustrated and embarrassed. Once again, the patient’s story has changed between the time you asked the questions and the hospital staff asked the questions.

Why does this happen?  Do patients just lie? Are they forgetful?  Are they ‘out to get you’? Is it just ‘part of the business’ and do we have to accept it and move on? Or is it possible that it is something we may or may not be doing and might be able to improve on?

A big part of the communication process requires us to be good listeners. Improving on history taking skills may not be as easy as reading about disease conditions or memorizing AMPLE and OQRST pneumonics. We need to look at how we listen to the answers and improve these skills.

There are a lot of reasons why it is difficult to listen. The following nine examples are reasons why it may be hard to listen.

  1. Message Overload. Sometimes the information is just too much. We’ve heard the chest pain description so often we know it by heart and our attention wonder If this is your tenth chest pain call this tour and it starts out sounding exactly like all the others, you may unconsciously stop listening.
  2. Preoccupation. We often have other things going on in our lives that make it difficult to concentrate on the message at hand. Concerns with home life, our skill levels, worrying about what might happen if the patient crashes, possible drug doses, et may intrude on our ability to concentrate on the message.
  3. Rapid Thought. We are able to listen at a much faster rate than most people talk. We can listen at a rate of about 600 words per minute while most people talk at a rate of 100 to 150 words per minute. This gives us a lot  of ‘spare time’ to think about other things, many of which have nothing to do with the patient or problem at hand.
  4. Effort. Listening effectively is hard work. Studies how heart rates, respiratory rates. and body temperatures all increase when a person is concentrating on listening. Sometimes we are just too tired to listen.
  5. External Noise. Sometimes we simply can’ t hear patients properly due to external noise. We tend to work in noisy environments that are often not conductive to listening. Cutting or extrication tools, stereos, TVs, street noise, and bystanders may all impede our ability to listen.
  6. Hearing Problems. Consider the damage done to the average EMS worker’s ear drums during the course of a career. It may be slight hearing problems are actually interfering with our ability to listen. Others may not be able to hear you due to hearing problem as well. This however is probably less often the case then we think.
  7. Faulty Assumptions. EMS worker usually tend to be quick decision makers. This is a necessary skill, but it may also negatively impact our listening ability. Often, we quickly jump to conclusion s from limited evidence. We think we’ve heard it before, can predict the rest of the message or figure it is unimportant and we shut off.
  8. Lack of Apparent Advantages. We often think we can gain more by speaking than listening. This may cause us to interrupt or give more information than we receive.
  9. Lack of Training. The ability to listen well is not a naturally acquired skill. It takes, work, practice, commitment and effort.

 

Because of these difficulties most of us have actually learned how to not listen and have perfected our art. Evaluate which of the following types of non-listening techniques you may have developed.

  • Pseudolistening. In this case the listener appears interested but is really ignoring the talker. In this situation the paramedic nods his head and appears to be listening, but is already thinking ahead, thinking the patient will be describing typical chest pain so misses that it radiates into the back. Our non­verbal actions suggest attention so the talker think s he or she is being listened too, but in fact is not.
  • Stagehogging. In this behavior style we only want to talk, not listen. In EMS work we sometimes get very engrossed in telling the patient why they should go to the hospital instead of listening to their reasons why they don’ t feel it is necessary.
  • Selective Listening. This type of non-listening style involves responding only to parts of the conversa We hear the asthma patient say they are short of breath, but we miss that they are also having chest pain.
  • Insulated Listening. This is the reverse of selective listening. Instead of attending to selected parts we ignore or insulate ourselves from information. If we are prepared to handle the trauma call and are psyched for that, we may ignore the information that the patient felt dizzy and lightheaded prior to the crash.
  • Defensive Listening. This type of listener feels everything said is a personal attack and prepares for battle rather than really listening to the message. If you feel unsure of your skills because you are a rookie, and a patient asks you how long you have been in the business, you may respond very defensively. You may argue that you know what you are doing when in fact the patient was merely looking for a conversation piece and was not questioning your skills.
  • Ambushing. Ambushers listen very carefully but only for the purpose of attacking you later, looking for loopholes. The apparent sympathetic partner who listens to you rant and rave about a supervisor, only to present what you said to that supervisor is an example of this.
  • Insensitive. This person doesn’t look beyond the words said but takes the patient at face value. This type of listener does not look for non-verbal cues that might contradict what a patient is saying and therefore may miss the true context of the conversation.

 

Knowing why and how you don’t listen is the first step to improvement. Once you understand what you are doing you can take steps to improve. The following are general steps to improve your listening skills.

  1. Talk Less. This rule of thumb is particularly helpful for the stage-hogger. If at the end of the call your patient knows more about you than you know about your patient, something is wrong.
  2. Get Rid of Distractions. This means you eliminate both the internal and external distractions – turn the TV off, get the patient alone or into the back of the unit, get your private life under control so you can concentrate on the patient at hand, etc.
  3. Don’t Judge Prematurely. Having an open mind and not labelling patients based on dispatch information or initial presentation will allow you to avoid defensive listening selective listening and insulated listening.
  4. Look for Key Ideas. Pick out key pieces of information and ask the patient to expand on those areas. Help the patient stay on track and keep yourself on track and attuned to the patient Make listening a truly active event.
  5. Paraphrase. Restating the patient’s words helps ensure you have selected and understood the right information. Before you repeat the history or state your pitch, play it back to the patient and allow them to clarify any areas you might have misunderstood.
  6. Ask Questions. Don’t be afraid to ask questions. Often, we remain silent because we are afraid, we will appear stupid. Patients appreciate your openness. It is important they are understood. Work on asking more open-ended questions than closed questions.
  7. Practice. As always in the communication game, you need to work on and rework your approach. Never give up but look within to see where you went wrong and where you might improve. The only half of the communication process you can change is your half.

Any communication exchange involves two or more parties.  If you are not getting the history you need, consider it may be at least 50 percent your fault. We don’t always have enough time with patients to work on their communication skills, so we have to look at our own. Emergency medical services is a client-centered occupation and improving our listening skills is one way of improving customer service.