Humanist Perspectives: issue 153: Listening

practical philosophy
by Trudy Govier

drawing by Todd Stewart

drawing by Todd Stewart

It was some time last August when I read about someone setting off on a listening tour. Clearly worthwhile, I thought, a charming alternative to the speaking tour. This person must have wanted to learn from others instead of lecturing to them.

What would happen if doctors went on listening tours? Or are they already doing a good job of listening — perhaps even more than their share?

When we listen, we indicate our sense that the other person has something to say and both she and her viewpoint merit our attention. She is telling her story, expressing her feelings, explaining how a situation seemed to her, or giving information. Whatever it is, we can’t comprehend it without listening. Listening requires active attention. Mediators talk about active listening. What they recommend is eye contact, body language indicating attention, and the use of tokens of assent (“Oh really?,” “um,” “so it seemed really serious to you?”) as expressions of attention. Mundane as this may seem, it’s really important. I once attended a mediation course from a woman who gave the assignment of listening to another person for five minutes without interrupting in any way except to express verbal gestures of attention. The idea was to listen and attend, not to wait impatiently for a break when we could insert our own comments. It’s surprisingly hard to do.

Listening is a matter of acknowledgement and consideration; it does not require agreement.

Listening indicates acknowledgement and, in that way, respect. When we listen to another, we acknowledge that he is an other, someone with human status and a perspective on the world that is not ours but still deserves respectful consideration. Listening is a matter of acknowledgement and consideration; it does not require agreement. We may decide in the end that this person’s stories are boring, his emotions over-blown, his information unreliable. But to reach that point in anything like an informed way, we need to listen first.

Within philosophy, Martin Buber and Simone Weil have emphasized the ethical and epistemic importance of paying attention to other people. Buber distinguished relationships of ‘I/Thou’ from those of ‘I/It.’ Another human being is a person, not a thing, a subject not an object — and should be treated accordingly. Crucial to acknowledging the human dignity of the other, showing concern and respect, is listening, really engaging in a dialogue. Weil’s views are similar.

So far as acknowledgement is concerned, the fact that people seek and appreciate acknowledgement has an important corollary: the absence of acknowledgement leads to alienation, frustration and resentment. When people don’t listen, we feel as though they don’t care about us and can’t bother to pay attention. I think the issue of not listening is serious. It marks a failure of respect in a relationship. Furthermore, it deprives the inattentive person of information that could be important.

How about doctors? When a doctor fails to listen, we will likely suspect such a person would like to get us out of her office as quickly as possible; if she has to write a prescription to do that, she will. It is worrisome to think that relevant facts about our problems are going unheard and the piece of paper we are handed might provide something unsuitable or even harmful. It doesn’t make for confidence.

The hectic and technological nature of much contemporary medical practice means that often doctors do not have the time, or do not take the care, to listen to their patients. Their failure to listen often strikes patients as a failure to take them seriously, and is a motive for seeking out alternative practitioners, who offer (for a fee) lengthier appointments and seem to listen more carefully.

Perhaps I’m too sensitive and overly influenced by my personal experience. I seem to have the sort of body that’s unusually sensitive to medications and I’ve experienced great difficult getting doctors to take side-effects seriously. I’ve recently had several encounters where the doctor talked to me while making notes on a computer. Any I/Thou sense was seriously diminished as a result. I was given a print-out of the notes and several times they contained highly significant errors. Like most human beings, these doctors were apparently none too proficient at doing several things at once.

Recently, because of the scandal about Vioxx it has been suggested that doctors be required to report adverse effects of medications. It seems like a good idea, but, given my own experience, I wondered how many adverse effects go unremarked because doctors fail to credit their patients’ experience. Let’s hope the problem is rare, but my personal experience suggests otherwise. Brown spots on my face, hives, muscle weakness, orange skin and serious eye problems are only a few of the side effects I’ve suffered. In all these cases, doctors firmly denied any effect of recently prescribed medications — even though in all cases the effect started soon after the medication was started, ended when the medication was stopped and had been reported, though stated to be rare. If doctors were required to report adverse effects, they would never have reported these problems because they never acknowledged them in the first place. I’ve just about given up telling doctors about side effects. If others have done the same, the failure to listen and attend could mean that adverse effects are being seriously under-estimated.

If doctors often fail to listen to their patients, why would that be? Doctors are busy people; general practitioners in particular are underpaid; they tire of hearing the same sorts of stories again and again. Some patients get ideas from friends, the Internet, or alternative practitioners. Patients may have faulty memories, exaggerate side-effects, or reason fallaciously about what causes what. And after all, if a patient knew what the problem was and knew how best to respond to it, why would he be seeing a doctor?

One approach to understanding this problem might be to listen to some doctors. I’ve heard some relevant ideas from doctors who are personal friends. One mentioned a patient who was describing her allergy to cats and then went on to say, “oh, and I’m allergic to dogs too.” That detail was medically irrelevant, the doctor said: the treatment is the same for both. Another doctor mentioned her sense of boredom and impatience with older patients who complained frequently of back pain. She told me she felt inclined to say, “you’re a human being; human beings get back pain; what do you expect?” and had to bite her tongue. Thinking she should have been more patient and willing to listen, this woman left the tedium of general practice to become a professor of education. Another doctor was a young woman already frustrated with patients expressing great confidence in naturalistic ‘remedies’ like putting cucumber slices on one’s sunburned thighs. Yet another expressed exasperation at patients who would arrive at her office and place hundreds of dollars worth of ‘alternative’ products on her desk. They had been willing to pay for these but nevertheless expected to get free advice from her; she was a qualified practitioner who had paid high fees and laboured mightily to get through medical school. Another doctor was a superb listener but then became overwhelmed by depression. She took a leave from her practice and then retired. Other doctors were just plain rushed, too busy to listen.

All of which is just to say that if doctors don’t listen, there are causes for the phenomenon. And in some cases, there may even be justifications. But this is not to deny the importance of listening, and if doctors are too hassled to listen to their patients, we’ve got a real problem on our hands. Listening is a perquisite of getting reliable information. Even more fundamentally, it’s a prerequisite of decent and respectful relationships.

Trudy Govier is the author of many books, including Forgiveness and Revenge, Dilemmas of Trust and A Practical Study of Argument.