“You keep telling us to listen, but how do we listen?” The student asking the question seemed exasperated, and, as I looked around the room, I sensed that he might be voicing the frustrations of many others. I had been admonishing them, “You’re not listening.” They assured me that they were. I countered that they weren’t, so they challenged me to tell them how to listen.
Now I was frustrated. I was teaching about the importance of listening to our patients, and my students didn’t seem to understand how to do it. Listening is something that appears easy but is actually hard to do. We know that we need to listen to our patients, but how do we do it? What is true listening? I thought I knew but couldn’t explain it in a convincing manner.
I’m sure that my answer to the student’s challenge on that day was inadequate, and it was some time later while I was reading in Japanese that I came across the word to listen—kiku
. I realized that I had found what I needed.
Kiku is composed of several parts. There is an ear
, which is no surprise, as in listening we use our ears to hear what is being said—not just the words but the way in which something is said, the tone of voice, the flow of speech.
Kiku also contains the number 10
and an eye
. Together they indicate maximal seeing, as listening requires all our senses. So much communication is nonverbal—patients give messages through silences, gestures, facial expressions, and bodily postures, and it is our task to create meaning from these different and even contradictory sources of information.
More ancient versions of kiku also contain the symbol for king
, implying respect for the storyteller, and a number 1
, showing the importance of focused attention. There is no mouth in kiku, telling me that our desire to speak often interferes with our ability to listen. While there is a time to ask the right questions, we need to stop interrupting so that the patient can tell his or her story.
in kiku impresses me the most—we listen with our hearts. This is the basis of empathy, feeling what another is feeling, and of compassion, feeling moved to alleviate their suffering. Perhaps our ability to listen works much like the diastolic function of the heart—to receive blood in a state of relaxation and expansion. We accept what the patient communicates by creating space within ourselves. We may also go out to meet them more fully just as the heart pumps blood to the body. The heart is both an open receptive dimension of our being and an active expansive opening to the world.
Reflecting on kiku has helped me to understand how complex true listening really is. It demands overcoming our inner distractions and desires to assess, analyze, interpret, diagnose, and prescribe by concentrating the full power of our presence on the patient. We have to wrestle with a misguided sense that listening is a waste of time in our evolving sense of professionalism and begin our care by listening to the patient and confirming our reception of their story. Listening allows us to see their needs and desires and receive their suffering, realizing that in our hearts we are no different from them, giving rise to compassion.
Now I use the wisdom in kiku when I try to convey the meaning of listening. Students understand when I ask them to listen respectfully, totally, mindfully with their ears, eyes, and heart, joining with the patient as a whole presence, feeling their anguish and extending empathy and compassion. They find that when they listen with their hearts, patients tell them more about their lives, mutual trust builds, and healing occurs. They may hear something important that helps them to understand their patients’ illness better and take efficacious action on their behalf. Or they may simply bear witness to their suffering, and in so doing, help to heal their patients’ wounds. Listening with the heart may be the best they can offer; at times it may be all they have to offer.
Stephen Murphy-Shigematsu, EdD
Dr. Murphy-Shigematsu is consulting professor, Stanford University School of Medicine and Stanford School of Humanities and Science, Stanford, California, and Fielding Graduate University, Santa Barbara, California; e-mail: [email protected]