How Will This Module Help Me?
Learning Objectives:
Identify the benefits of listening with empathy
Demonstrate best practice techniques to listen for underlying feelings, needs, or values
Apply empathetic listening techniques to build trust and improve patient experience
Expressing empathy is a key ingredient to enhancing the patient experience. In fact, 65% of patient satisfaction has been attributed to physician empathy.1
The feeling of being understood by another person is intrinsically therapeutic. It bridges the isolation of illness and helps to restore the sense of connectedness that patients need to feel whole. The foundation of empathetic communication is based on accurately understanding the patient's feelings and effectively communicating that understanding back to the patient so the patient feels understood.2
In this current era of COVID-19 with unprecedented levels of uncertainty and anxiety, it is even more crucial that clinicians employ empathetic listening to understand and allay patients' fears and concerns.
Empathetic listening is a simple yet powerful approach
Empathy begins with “engaged curiosity about another's particular emotional perspective.”3 Empathetic listening builds on the concept of being attentive to better understand another person's experiences. Empathy is also described as the capacity to put one's self in another's shoes to feel what that person is going through and share their emotions; the recognition and validation of a patient's fear, anxiety, pain, and worry; and the ability to understand patients' feelings to facilitate more accurate diagnoses and more caring treatment.1 By connecting with empathy, you can help to alleviate fears and convey that you and your care team are listening to their concerns.
Quiz Ref IDTangible and intangible benefits to listening with and demonstrating empathy include3:
Greater therapeutic efficacy
Increased patient trust, which may increase the amount of information the patient discloses and improve adherence to treatment
Improved communication between patient and practitioner, which may decrease patient anxiety and improve the patient's and physician's abilities to cope in emotionally charged interactions
Patients who feel understood are often more open and responsive to their physician's advice. In return, physicians may have an improved sense of professional satisfaction and joy in work.
Five STEPS to Listening With Empathy
Connect with Empathy by Honoring the First “Golden Moments”
Listen for Underlying Feelings, Needs, or Values
Remain Present When You Are Listening
Look for Cues to Speak Versus Listen
Reflect on Your Experience
STEP 1 Connect With Empathy by Honoring the First Golden Moments
In a clinical situation, the first few minutes of the encounter are precious. During the initial patient visit, you may feel pressured to dive into the various clinical tasks that need to be completed. However, if you leap into these tasks without listening to the patient, you may miss critical information. Take the time to honor the first “golden moments” of the visit by setting aside distractions such as charts, computers, phones, alarms, and pagers. Giving the patient your full attention at the start of the visit prevents important issues from surfacing at the end and will allow you to better understand the patient's concerns or symptoms. While the first few minutes of a visit are important, you should continue to be fully attentive throughout the interaction to ensure that you capture any concerns that may be revealed later in the visit.
STEP 2 Listen for Underlying Feelings, Needs, or Values
Sometimes feelings may be right on the surface, but at other times they can be hidden. Patients often mention emotional situations, and then wait for a practitioner's cue that it is okay to continue. As the patient explains the situation, watch for feelings hidden in body language, facial expressions, or other non-verbal cues. As your interaction continues, take your own emotional temperature and note your own internal feelings like anxiety, sadness, or frustration. Use the patient's non-verbal cues to assess if this is an opportunity to switch from medical questioning to empathetic listening. To switch to empathetic listening, allow for a brief pause in the conversation, soften your tone of voice, and ask a question that is directly related to your interest in the patient's feelings. This strategy invites the patient to express their concerns, and allows you to address the patient's unique needs.
Identifying Underlying Needs (520 KB)This tool will help you gain a deeper understanding of the underlying needs we all have but may not openly or knowingly express, with examples of how needs may be expressed in conversational language.
We all have common needs, but different ways of acting in response to these needs. When we focus on needs and values, we can identify ways in which we are the same. During empathetic listening, focus on the patient's underlying needs, rather than their communication style or behavior. You may not know what the need is at first—be open and ask questions until you reach a common understanding.
There might be situations where you may not be able to identify the feeling that the patient is experiencing. In those circumstances, it is important to emphasize that you are interested in hearing about the patient's experiences. Expressing interest invites more expansive conversation, and increases the probability that the patient will reveal underlying feelings.
STEP 3 Remain Present When You Are Listening
Give patients an opportunity to express their feelings to completion, without interruption. Their feelings and values will surface if they are given ample time to express themselves in a welcoming environment. Focus on moments when the patient seems to display the most energy around a topic (eg, more rapid speech, change in facial expressions, more pronounced gestures) as these signs can provide clues to what the speaker values most. Embrace silence to allow for a compassionate experience.
“With empathy, we don't direct, we follow. Don't just do something, be there.”
—Marshall Rosenberg, PhD, Founder and Director of The Center for Nonviolent Communication
STEP 4 Look for Cues to Speak Versus Listen
Quiz Ref IDThere are opportune moments for verbal responses to what the patient is sharing. Cues might be a decrease in emotional intensity, a deep sigh, or a shift in the focus of the conversation. At this point, it may be natural to respond to their message and attend to the medical care needed. Verbal reflection may be helpful for conveying empathy when you need more description or explanation from the patient, or when you sense the patient would like confirmation that you are listening and understanding.
When you respond, keep this question in the back of your mind:
“Is the patient feeling [this emotion] because they have this particular [value or need]?”
As you respond, it is important to speak naturally and be yourself. At this point in the dialogue, the focus is still on listening and it is not the time to share your experiences or opinions. Listening with empathy has a reflective quality that allows the patient to reach a deeper level of self-understanding.
You may also want to be mindful of actions that suggest a lack of empathy. These include:
Interrupting or finishing the patient's sentences
Challenging the patient's feelings
Speaking in a manner that sounds patronizing
Describing what the patient ought to think or feel
Lack of emotional acknowledgement by changing the topic and proceeding with medical questions
Identify and Overcome Deflective Listening (51 KB)Use this tool to understand and overcome barriers to empathy.
STEP 5 Reflect on Your Experience
Quiz Ref IDAs you reflect on a conversation in which you listened with empathy, begin to think about how you are feeling. Is there anything you are grateful for in this specific interaction? Is there anything you would do differently next time? Offer yourself a chance to be heard and understood for your own experiences.
You can use empathy to reflect on your own underlying feelings and experiences using the same steps outlined here. For emotionally charged situations, writing narratives about your experience can be helpful. Find a listening ear for yourself, and if you want, request that they listen without offering advice or solutions to problems. It may also be helpful to seek trusted colleagues and mentors with whom you can share some of the emotional impact of patient care.
There are many venues in which you can safely share these emotions, you may consider these or others:
Worksheet for Self-Reflection (48 KB)Use this worksheet to restore yourself for the next time you listen with empathy
Listening to others with empathy is a skill that can foster trust in the patient–physician relationship, increase collaboration among co-workers, and enhance personal well-being. Focusing on a patient's underlying feelings demonstrates that you are committed to understanding their experience, and your choice of language and other non-verbal responses is key to drawing out their feelings and values. In a clinical setting, patients are more likely to hear you and be open to your counsel if they sense your empathy.
Empathetic Listening: Additional Reading and Resources (789 KB)This document lists articles and resources recommended for more details on empathetic listening.