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Better listening: It's an active process

Soika, Tina

doi: 10.1097/01.HJ.0000292843.26568.e7

Tina Soika is President, American Hearing Aid Associates (AHAA), West Chester, PA. Readers may contact the author at or 800/984-3272.

Good listening skills are a defining attribute of nearly every successful hearing healthcare professional.

This may seem like such a basic; however, when we review and improve our professional skills, better listening is often overlooked. We spend much time and energy learning new software, fitting techniques, and product specifications, but not on developing our ability to listen. As a result, some persons do not employ even the simplest ways to be a better listener, such as making more eye contact or leaning toward the patient.

Most of us could benefit from improving our listening skills. Assertive persons, especially, could learn to listen better. So could those with a great wealth of dispensing experience, but who may have become a bit jaded over time. When that happens, practitioners may start to lose their ability to focus, listen, and interpret unencumbered by pre-formed opinions.

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The best way to boost our positive effect on patients, to cultivate empathy for them, and to understand their needs is to listen to them effectively. The keys to discovering what they want are simple and old-fashioned: Ask the right questions, listen to their answers, relate them to your knowledge base, and turn to action.

It used to be that “ask” meant one thing only: Ask for the order. Indeed, many “sales” still hinge on that tired philosophy. At AHAA, we believe in a definition of “ask” that focuses on ascertaining needs. For example, how often do you ask patients how they are going to use your product or what they like most about it? Or, when did you last ask a patient how your products might affect their relationships with others? Those are examples of the right questions to ask patients. And when we listen effectively to their answers, we can better go about the job of hearing rehabilitation by providing better solutions.

We are living in the age of the customer. Our patients have more choices of more products from more providers than ever before. Our services and our products compete with myriad others for our patients' attention and action. Clearly, the practice that can deliver convenience, quality of product, and exemplary care is going to be successful. One element of differentiation from the competition in terms of care should be our ability to listen effectively.

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It's human nature to have an agenda, a pre-determined mindset, and to rely too much on our own impressions and past experience.

This is especially true in the workplace, where we rely on precedent and previous fittings with similar hearing losses and similar patients to make recommendations and suggest courses of treatment. Often we hear what someone is saying to us, but we fail to process it into a conceptual idea of understanding. Some refer to this as the “old married couple” syndrome, though a better term in this context is “passive listening.”

Another time when we may be doing passive listening is when we already have an opinion before we even begin to listen, let alone hear the patient's full story. Then, as the patient tells us his story, we daydream and fail to focus on what we are hearing—or ought to be hearing. Signs that persons are in a passive state include fading to black and fixating on an idea.

To make matters worse, studies show that most of us understand, evaluate, and retain only about 50% of what we hear and, 2 days later, we remember only half of that. In other words, we comprehend and retain only 25% of what we discuss with our patients! Passive listening can shortchange you and your patient.

By contrast, the state of active listening is one in which a person has an acute sense of awareness and is actively internalizing and cataloging incoming information. When hearing healthcare professionals are listening actively, they create concepts in their minds about what the patient needs and the benefits that they can offer to the patient.

Here is another point that may help illustrate the importance of being an active listener: Most of us speak at a rate of about 100 to 150 words a minute, yet we can listen at a rate of about 400 words a minute. The difference between the two is “lag time.” Active listeners use this lag time wisely to analyze what patients are telling them, watch their body language, and develop strategies to help their patients hear well.

We can all train ourselves to use lag time more effectively and maintain a state of active listening. If you are not in the mode of fully active listening with your patients, at best you will miss opportunities to help them and, at worst, you may even contribute to their becoming unhappy or angry. And lost opportunities, of course, mean lost income.

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LISTENing actively

Being a good listener should be an integral part of our professional skill set. And good listening skills can be developed, nurtured, and improved. For example, along with making more eye contact and leaning forward, there are other techniques professionals can use to improve their listening ability, such as nodding the head to indicate understanding and encouraging patients to speak.

Another method of becoming a better listener is to ask questions. Patients do not always know what they want or need. So as we listen attentively, we can give them points to talk about. We can tell them and indeed show them how better hearing is possible.

For example, use the words “feel, felt,” and “found” in your questions and comments. Ask patients how their hearing instrument makes them feel. How would their spouse feel if they resolved their hearing problem? Tell them that in the past you have felt or other patients of yours have felt the way they feel now and that you know how difficult it is. Tell them that you have found that people who wear hearing aids improve their quality of life and their relationships with loved ones and friends. Then let them tell you what impresses them about your presentation. And listen.

In a state of active listening, focus not only on the content of what your patients are saying, but focus also on their inflections and tones. Listen for clues that tell you whether or not you are communicating effectively.

Eliminate distractions. Ensure that the setting for the evaluation is free of interruptions both from your staff and from the outside.

Take notes at all times. Listening involves interpreting, so interpret quietly, taking notes. Try not to interrupt while patients are explaining their problems, wants, and needs. Your best thoughts may come while patients are talking, but it may not be appropriate to express them at that time. Again, remain focused and allow your patients to remain focused.

Ask even more questions, especially open-ended ones. They help persons explore their feelings. Avoid questions that can be answered shortly with a yes or no.

Paraphrase or restate in your own words what patients have said. Here is an example. The patient says, “My wife is always complaining that she often has to repeat what she says to me.” You reply, “Are you saying that she does not think you hear well?” Paraphrasing or restating shows that you are indeed listening and that you understand and are grasping the facts.

Encourage dialogue. Empower patients to talk. Let them know that you are very much interested in what they have to say. Assure them that what they have to say is very important to you and to helping them hear better again. And mean it! Don't interrupt. Do not agree or disagree. Use noncommittal words to keep the patient talking (“I see…that's interesting….”). Effective listening has a 60:40 rule. Patients should do 60% of the talking.

Finally, summarize at certain points during the evaluation. Pull important facts together by restating, reflecting, and emphasizing what you have heard: “These seem to be key ideas….” This establishes a basis for continuing the discussion by focusing on patients' main ideas and feelings. Summaries also help review progress toward reaching patient goals of better hearing.

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As you work to improve your listening skills, do self-assessments. After each session with a patient, ask yourself the following questions:

  • What did I learn from the patient?
  • What did I learn about the patient?
  • Who did more talking?
  • Who did more listening?
  • Did anyone or anything interrupt us?
  • What questions should I have asked?
  • Was I certain that I understood everything?
  • Did I ask for clarification?
  • Did I practice acknowledgment?
  • Did either of us keep changing the subject?
  • Was either of us angry or sad?
  • What will I do differently with the next patient?

Your answers will help you measure your progress in learning to be a better listener.

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Active listening is a state that good listeners strive to maintain throughout their workday. And becoming a more skilled and attentive listener can be learned with practice, attention, and discipline.

For some, increasing retention and breaking ineffectual listening habits may take time and energy. However, better listening will bring you many rewards in your interactions and relationships with patients. These rewards include serving them better and enhancing your practice's reputation and success.

Using better listening techniques will also improve your relationships with your staff and your own loved ones, which will in turn cause you to perform better in the workplace.

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