The previous blog in this series on communication considered non-verbal communication – the message that your practice conveys through it’s leaflets, website and practice environment. Today we are going to think about listening.

Last week I pointed out that the first sentence in the Osteopathic Practice Standards guidance is ‘Poor communication is at the root of most patient complaints’. The first sentence of the standards is ‘You must listen to your patients and respect their, individuality, concerns and preferences.’ Listening is fundamental to good communication and good patient care.

The art of listening

How often does someone really listen to you? Undistracted listening is quite rare today. In fact, a lot of people don’t have long, meaningful dialogue with anyone. Communication has been reduced to bitesize sentences through electronic communication.

Listening is a skill that needs to be practised. If you can really listen to a patient’s words and non-verbal communication in a focussed and undistracted way you will find it really enhances your communication.

One of the pressures in clinic is the constraints of time so you may feel pressured to move the patient swiftly through their story. The other distraction is your diagnostic reasoning. As the patient is talking you are reasoning out your diagnosis and sometimes this can distract you from what your patient is really saying. Are we really listening or thinking of our next question?

There has been quite a lot of research and sharing of knowledge in healthcare on communication skills so I will share some of the advice relating to listening.

Listening skills

Start by listening

There is a lot of benefit in simply allowing the patient to tell their story – most will stop after 60 seconds and usually no more than 150 seconds. Allowing the patient to speak uninterrupted gives them the opportunity to really  feel valued and listened to.


Listen to the patient’s words, observe their facial expressions, gesture and postures. Most communication is non-verbal.


The tone of the voice – pick up on anger or depression. Underlying messages

Don’t interrupt

Keep listening, not thinking of your next question. Listen to what they are really telling you.

The importance of listening

Listening well will help you to identify what really matters to your patient. What are they no longer able to do? What other issues may have contributed to their pain? Are there metaphors they are using that give you further insight into their pain?

Patients will often tell you what is really bothering them whether it is during the case history or whilst being treated. Maybe they are having issues at work or there are concerns within the family, perhaps they have stopped exercising or activities they enjoy, maybe they are simply unhappy. The osteopathic scope of treatment is not to offer counselling but often acknowledging how other factors may be influencing symptoms can in itself be an enormous help to patients. Supporting patients to identify how they can reach their goals can also be helpful.

For repeat patients one of the best things you can do is listen. Many patients will share things with you that they perhaps never discuss with other people. Often you don’t need to offer a response, simply a listening ear and perhaps a supportive question.

An insight into metaphors

Metaphors are a really interesting subject. I know there is a physiotherapist, Mike Stewart, doing a PhD on metaphors so it is a huge subject which I will simply touch on. Patients will often use phrases such as pressure, tight, stabbing. You might then consider – is there something that is making you feel under pressure? Why do you feel tight – are you under tension or trying to hold something together or feeling wound up? Is there something that has happened like a stab in the back? You might not ask these questions overtly but they can give you a clue to opening up the conversation in a particular direction. There are lots of common phrases that can give insight into pain too – ‘pain in the neck’, ‘on my knees’, ‘carrying a heavy load’ and I’m sure you can think of more. Being aware of metaphors can often give you insight into helping your patients understand issues underlying their pain. This is an area which takes practice to hear the underlying message and good communication skills to help the patient identify those issues.

Listening is a skill that can be practised in all sorts of situations. It is a lifelong skill that can continuously be practiced and improved.

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