Monday, 9 December 2013

'A Straight Talk' or 'A Straight Listen'?

A health professional at a recent workshop passionately exclaimed, ‘sometimes I have to give my patients a straight talk!’ By ‘straight talk’, the health professional meant telling the person exactly where they were going wrong with their diabetes management and what the consequences would be if they did not change their ways.

I do not doubt for a moment, the health professional’s motivation of concern for the health of those on the receiving end of the ‘straight talk’, nor the desire to help achieve the diabetes recommendations which are widely published and to which such health professionals, among others, are often held responsible.

Rather, what struck me about this encounter was the idea, in our evidence-based world, that such a strategy would work to improve the situation. In fact, evidence suggests exactly the opposite, that is that a telling off (for that is what was really meant by a ‘straight talk’ in this case – I knew it because the words were accompanied by a wagging finger) is likely to make people highly disinclined to make changes and distinctly unwilling to return to the clinic or a consultation with such a health professional.

What might be a more helpful and effective strategy is one I encourage any health professional in such a situation to consider, and that is a ‘straight listen’. This consists of asking a few interested open questions and actively listening to the answers, with the aim of experiencing the world through the eyes of the person with diabetes and to help address the challenges they face. ‘A straight listen’ has many advantages, among them:

It engages the person in talking honestly about their concerns about their diabetes and their thoughts and wishes about addressing them
It is more friendly and less stressful
It creates an equal contribution and participation in the consultation
It results in increased motivation to take action outside of the consultation
It takes less time and energy and gives much more satisfaction

Sometimes, listening is thought of as a ‘soft’ skill or ‘a bit touchy feely’ as described to me by another health professional recently. However, in survey after survey of people, especially those with long-term conditions, active listening and being non-judgemental are cited as missing, and strongly wished for from health providers. A recent example is a survey published in Diabetes Update. How can it be that something so apparently simple and so desired, is so comprehensively overlooked?

In my experience, there is no shortage of health professionals expressing a desire to be better communicators or listeners, but a common reason given for not investing in actually using these skills more, is a lack of time in consultations. This is interesting, since there is evidence that consultations can be shorter where there is more listening on the part of the health professional and this also brings increased satisfaction on the part of the person with diabetes. There must be something else. I find myself wondering if part of this ‘something else’ is that being a health professional is so intrinsically linked to being an ‘expert’ and an ‘advisor’, that ‘simply listening’ means to give up these roles with the perhaps consequent loss of status or even competence? Another reason may be that, among health professionals, the skills of listening are much less practised, hence less habitual, than those of talking or telling, and so their confidence in using them is less.

As I continue my musings as to the underlying causes are of the continuing need among health professionals to deliver a ‘straight talk’ against much good evidence of its ineffectiveness, I have a new offering to try and make ‘a straight listen’ more accessible and easier to learn and practice.

From today, SD’s latest download is ‘A Little Book of Listening’, a booklet with some inspiration, ideas and practical ways to use listening in consultations – and indeed in other areas of life, too. I hope that providing and spreading the word about this will go towards helping some poor souls avoid being on the receiving end of any more ‘straight talks’ next year!

Sincerely wishing you a listening 2014

Grant, P. (2013). What do Patients want from their Diabetologist?. Diabetes Update, Winter 2013

Successful Diabetes (2013). A Little Book of Listening

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