I wasn't always a good listener. In fact, I've spent a substantial chunk of my time on this planet speaking quite a lot, listening very little, and wondering why no one ever listened to me. It was my clinic patients who turned me on to the realization that holistic wellness includes the need to feel understood. I began incorporating this into patient visits: affirm what is good and recognize that other people see the world through their own perspective, which is different from my perspective, and which is their reality! The results were extraordinary. Genuinely listening with the intent to understand, reserving judgement, and empowering patients to direct their own path to health went a long way in establishing the rapport necessary to build an effective patient-provider relationship.
Let me illustrate with an example:
Pharmacist: "Hello, patient. I'm Kelly, the pharmacist. It's good to see you again. What's been going on since our last visit?"
Patient: "I thought everything was going well, but the nurse just told me my blood sugar is high."
Pharmacist: "You sound concerned. Why do you think it's high?"
Patient: "I don't know. Maybe from the snack I just had. I was really hungry in the waiting room and didn't want my blood sugar to get too low, so I ate a Snickers bar."
Pharmacist: "I remember last visit we talked about how low blood sugar can be dangerous. I understand how you would be concerned. How many times have you had low blood sugar since our last visit?"
Patient: "I don't think I've had any because I eat a snack every time I start to feel hungry or weak. I haven't had any readings below 70 when I check." (Pulls out BG log)
Pharmacist: "Thank you very much for bringing this log. Last time you said it was difficult for you to keep a log and remember to bring it in. I think it's great that you are taking the extra step to monitor and record your blood sugar, even though it's not easy. It will help us work together to get your diabetes under control."
Patient: "I really want to get it under control."
Pharmacist: "Then we'll figure it out together. Tell me more about your diet since our last visit. We decided that you would stop drinking soda and replace it with water. How's that been going?"
Patient: "I've been drinking mostly water and have cut way back on the soda. It's hard to cut it out completely because sometime I crave Coke and water is not quite the same."
Pharmacist: "It sounds like you've made progress. Congratulations! Change is not easy. You should be proud. Let's talk about the snacks you eat when you start to feel hungry or weak. You said you ate a Snickers bar in the waiting room?"
Patient: "Yes. I know it's not the best for my diabetes but it was convenient at the gas station check out line, and I was running late. I figured it was the healthiest candy bar since it has peanuts."
Pharmacist: "Hmm, it sounds like it can be challenging to find healthy snacks when you're in a hurry. What are some healthier snacks that you like to eat?"
Patient: "I like yogurt and sometimes peanut butter crackers. Those Glucerna shakes aren't too bad and they're pretty convenient."
Pharmacist: "What do you think would help you remember to keep peanut butter crackers or Glucerna shakes with you in case you get hungry?"
Patient: "Usually in the mornings I am in a hurry and that's when I forget.....It might help if I make sure they're in my bag every night before I go to bed."
Pharmacist: "Good thinking. Let's try that over the next few weeks, and we can discuss whether it's working at your next visit.
Patient: "Okay."
Pharmacist: "I'm so glad you brought this log because it's helping me see a picture of what your blood sugar is doing during the day. It looks like you need some extra insulin coverage around lunch time. How would you feel about increasing your dose of fast-acting insulin from 8 units to 10 units?"
Patient: "That sounds good."
Pharmacist: "Your A1c helps us see the big picture of your diabetes control. It has come down by almost a whole percentage point since we checked 3 months ago, which means you're making progress by using your medicine correctly and making healthier lifestyle choices. Change can be challenging, and we'll do it on your terms since it's your body. If you decide you want to be more aggressive, we can set some bigger goals, but if this is what you can handle right now, I understand and am proud of you for making progress."
(End scene)
Listening and appreciating what's good about another person is a subtle reminder that they have value in our eyes. It has the added benefit of expanding our own understanding of the world by challenging our own perspective, own our limited reality, by allowing us to put ourselves in another person's shoes and attempt to see the world as they see it. It is the start of an incredible journey to more fully understand the world as we know it!