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
Showing posts with label listening. Show all posts
Showing posts with label listening. Show all posts
Monday, 9 December 2013
Friday, 8 June 2012
Let's Hear it for Listening
Yesterday the Department
of Health announced a new rating for GP surgeries – marks out of 10 for
‘patient experience’. The rating is designed to enable people to make
comparisons between surgeries when deciding which surgery to register with. A
score of 10 is high and it is based on information given in the patient’s
survey, a questionnaire given to a random selection of people visiting their GP
after their consultation. You can see the ratings on the NHS Choices website.
A key new factor included
in the rating is ‘whether doctors and nurses are good at explaining things and
listening to people’ – part of the job description of a health professional,
you might think, and certainly this factor is welcomed by the Patient’s Association
who say they hear increasingly from people who are not listened to effectively.
However, this seemingly straightforward aspect of a consultation being rated
has raised some strong feelings among healthcare staff. A comment from a
practice manager in the health professional online magazine ‘Pulse’ yesterday
was that maybe patients should be rated on their ability to listen as many problems arose because
of people ‘failing to remember the basic information they have been told’. This
comment drew a number of ‘well said’s from other contributors, among them a GP
who felt that ‘It’s about time patients' responsibilities were highlighted as
well as doctor’s’.
It sounds from all this,
as though both patients and doctors feel frustrated – patients because they
don’t get enough time to take in information properly, and doctors and other
health professionals because their attempts to give the best care are hijacked
by government pressure and targets, for example having to deal with a number of
medical issues in only a 10 minute consultation. When stressed like this, it’s
not surprising that both parties are tempted to blame the other.
But could there be another
suspect entirely that is to blame for the mismatch between expectations and
reality? namely the system in which care is delivered. For example, we have
often heard from health professionals who have been given extended consultation
time alongside undertaking a course, to help people manage their diabetes more
effectively (‘Insulin for Life’: Chaplin, Widdowson and Reeve, 2012). They
report that they found the benefits of conversing with people in a more relaxed
way about their lives, challenges and hopes and dreams was incredibly useful,
not to mention satisfying. Even more importantly, this approach improved
outcomes for both patient and
health professional.
This would seem to suggest
that, in long term conditions at least, that systems need to change to
accommodate the needs. In the above example, many GP surgeries also began
dedicated clinics for diabetes as a result of their experiences, and have found
it a really effective way of meeting the needs of people with diabetes. This
suggests that there needs to be a practical and meaningful stimulus to make
change happen.
By coincidence, an
editorial in recent edition of Diabetic Medicine (Cradock and Cranston, 2012),
addresses just this point. The authors suggest that much more ‘emotional
mastery’ - support for people with diabetes to deal with the stress caused by
taking care of their diabetes - is needed alongside ‘insulin mastery’ (dealing
with the practical aspects). This suggestion is based on research showing that
at least some diabetes-related stress may actually come from the diabetes
consultation itself. This is because traditionally, the consultation places
medically-based expectations on the person with diabetes, causing feelings of
anxiety and guilt and thus contributing to raised HbA1c levels. Creating a
system of care which places much less emphasis on insulin and much more on
reducing the emotional effects of diabetes may well be an important factor in
reducing HbA1c – the ‘holy grail’ of most current diabetes services.
Perhaps the findings of
such a model could be shared with health services as a whole and adapted so
that both health professionals and people using their services can feel less
pressured, less blamed and become more healthy as a result? After all, as
Einstein himself said: ‘doing the same experiment over and over, and expecting
different outcomes… is the definition of insanity’. Perhaps given its benefits,
healthcare professionals may not be so defensive about changing the experiment
to include more listening?
References
Chaplin, S, Widdowson, J.,
Reeve, B. (2012). The Insulin for Life programme: nine years on. Practical
Diabetes, 29, 2 (supplement)
Cradock, S., Cranston, I.
(2012). Type 1 diabetes education
and care: time for a rethink? Diabetic Medicine, 29, 2, 159-160
Department of Health
(2012). Government opens up data to benefit patients and GPs online
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