Don’t Make Your Patient Visits Feel Like a Horror Movie

The scariest movie I ever saw was called “The Ring.” I’m not exactly sure what it was about, because I “watched” it while hiding under my jacket in the movie theater. Something about a cursed girl who lived on an island off Seattle, and she inadvertently made horses commit mass suicide, plus she also hurt a lot of people with her Jedi Mind Tricks, and her curse lived on through haunted videotapes. I think. There was maybe also something about a well, but that part was way too scary to even peek at.

Anyway, the point is that the only thing I remember clearly from the film (which, I’m told, is excellent. Love love love Naomi Watts!) is that at the end of the movie, the heroine realizes that at the root of all this evil is the fact that the cursed girl (Samara) just wanted to be heard. Perhaps killing people via haunted videotapes might be an overreaction, even if you feel like no one is listening to you, but if you have ever been ignored over and over again, you might have an inkling of what Samara was going through.

Extreme Japanese-horror-movie-remake examples aside, being listened to—being heard—is a universal need. When we are being listened to, it means that a connection has been made, that we matter, that our existence matters, and that we’re not alone. The privilege of listening is an awesome gift.

Confession time: I was not always a good listener. I think I may have been born a not-good-listener. There was that incident when Ms. Rosengarten (third-grade teacher) called my mother in tears because “Betsy just won’t stop talking.” I just chatted my way right through elementary school and junior high, leaving a trail of crying teachers in my wake.

As we all know, our mouths and ears cannot really be functional at the same time. So all that talking meant not much listening. I don’t think I really started learning how to listen until I was in college when the typical freshman adjustment period was accompanied by some fairly crippling social anxiety. Luckily for me, a professor noticed my panic in small class seminars and gave me some of the best advice I ever received: “If you don’t know what to say,” he told me, “ask people about themselves.” So I did. And since I had nothing else to do but pay attention, I got a lot of practice listening. After several years of listening, I feel like I got to be pretty good at it.

For some (unlike me), being a good listener comes naturally, but if it doesn’t, it’s not really a tough skill to master. Most, if not all, nursing programs actually teach therapeutic listening skills, but just in case you don’t feel like going back to nursing school, here are a few real-world tips that may help you be a better listener with your patients:

  1. Start every visit with open-ended, low-pressure questions. “How are you?” is a good one. “Did you have a good holiday?”, “How was the wedding?” or any appropriate topic you remember from the patient’s last visit can also work. We’re going for something personal but not expressly geared towards illness.
  2. Look at the patient. Not at the computer. Not at the chart. And certainly not at your watch or the clock on the wall. Just put your hands in your lap, smile, and look at the person who is talking to you.
  3. Wait for the patient to finish speaking. Then wait another few seconds. Your patient may be so surprised that someone is actually listening that it takes them a moment to go on, but once they realize you aren’t going to move on and jump in, they may get past a generic answer (“Fine”) and tell you something meaningful (“My daughter came to visit and I haven’t seen her for 3 years!”)
  4. Listening is not the same as waiting for your turn to speak. When a patient is talking to you, giving them your complete attention is a must.
  5. Periodically during a visit, and especially at the end, ask the patient “Is there anything else you want to tell me?” You may be surprised what they have been holding back.

So for those of you who are already gifted listeners, thank you and carry on. But if you are someone who often finds yourself distracted during patient visits or talking more than you listen, don’t worry, there’s a good listener inside of you just waiting to come out.

And for those of you who are intrigued by my first paragraph and are thinking it would be really fun to rent “The Ring” this weekend (and you value sleeping without nightmares), listen to me very, very carefully: Don’t.

Elizabeth Kirchner, CNP, RN-BC, is a nurse practictioner at the Cleveland Clinic in Cleveland, Ohio, and the Education and Curriculum Chair of the Rheumatology Nurses Society.