Hear Right, Say Right

The Art of Listening and Speaking in Healthcare

Professor London Lucien Ooi

MBBS (NUS), FCSHK (Hon), FRCSEd, FRCSG, MD (NUS)
Professor & Associate Dean, Duke-NUS Graduate School of Medicine
Professor, SingHealth Duke-NUS Surgery Academic Clinical Program
Professor, YLL School of Medicine, National University of Singapore
 Introduction
If We Don’t Communicate Well
Engaging the Patient
Engaging Colleagues
Final Words
Introduction
The young are not
communicating with
each other, not even
on the Internet
So what’s the relevance to me?
 Situations where you need to communicate

The Doctor-Patient One-to-One

Situations where you need to communicate

The Patient’s Extensions

 Situations where you need to communicate

The Healthcare Team Interactions

If We Don’t Communicate Well
 If we don’t communicate well
Patient Compliance Failures

A total of 127 studies supports the finding

that patient adherence is significantly
related to the communication of physicians
Physician communication and patient adherence to treatment –
A meta-analysis. Med Care 2009;47:826-34
 If we don’t communicate well
Patient Safety Failures
 If we don’t communicate well
Complaints Against Doctors
 When docs don’t listen to patients (ST 2011)

Doc’s listening skills just as important (ST 2011)

Engaging the Patient
 Initiating the Process

• The first impression

• The first touch
• The first words
• The environment
• Clinic setting
• Ward setting
 The First Impression

Ancient Egypt physician Iwty

The First Touch
Confident
Contractual

Calming
Comforting
 The First Words

“ Mr. Tan, ….”

“ Uncle, …..”
“ James, ….”
“ Sir, …..”
“ Eh!`…..”
The Environment

Ancient Greece
Athenian Physician
Jason,
200 B.C.
The Environment
The Environment
The Environment
The Environment
The Environment
 Effective Listening

• Listening without interruption

• Obtaining clarification and acceptance
• Responding
Listening without Interruption
Paying full attention
Eye contact
Nodding in understanding
Maintaining a bond

“Uh-huh.”
“I see.”
“Yes.”
“Go on.”
Obtaining Clarification
 Obtaining Clarification

We may ask for information,….

….. but we are only interested in what

confirms our opinions.
 Obtaining Clarification

“Are you saying … ?”

“Do you mean … ?”
“Did you say …?”
 Responding

Be quick to listen and slow

to speak !
Respond with compassion
& empathy.
Do not close the
conversation.
Watch for body cues.
Barriers to Effective Listening

• Lack of time & patience

• Distractions or lack of interest
• Language
• Physical barriers
• Emotional barriers
 Barriers to Effective Listening

Lack of time & patience

• Make the time
• Devote appropriate
allocation to each patient
• Avoid over-scheduling
Barriers to Effective Listening

Distractions/Disinterest
• Limit staff interruptions
• Pagers & handphones
• Paper work, documentation
• Relatives & friends
• Physician distractions
 Barriers to Effective Listening
Language
• Different languages, dialects, culture
• Universal language
 Barriers to Effective Listening

Physical barriers
• Speech impaired
• Communication impaired
• Listening environment
• PAPR
 The Listening Environment

Table positioning
Seating arrangement
Physical & visual contact
Room layout
Noise distractions
Movement disturbances
Barriers to Effective Listening

Emotional barriers
“Can’t stand his face”
“Can’t stand his voice”
“Reminds me of pet hate”
Personal problems/hang-ups

BE PROFESSIONAL
“Difficult Patients”

The “non-stopper”
The “know-it-all”
The “single-worder”
The “blank-wall”
 “Difficult Patients” - The Non-Stopper

The 3 C’s
• Control situation
• Contain response
• Confine to topic
 “Difficult Patients” - The Know-It-All

The 3 E’s
• Engage the topic
• Enlighten the patient
• Emphasis the point
 “Difficult Patients” - The Single-Worder
and The Blank Wall

The 3 R’s
• Relax the patient
• Relate to the patient
• Refrain
Engaging Colleagues
 Multi-disciplinary Team (MDT) Care

• Anaesthesiologist • Interventional Radiologist

• Cardiologist • Medical Social Worker
• Dentist • Operating Theater Nurse
• Diagnostic Radiologist • Organ Procurement Coordinator
• Dietician • Physiotherapist
• Hepatologist • Psychologist
• Hospital Admin Support • Transplant Coordinator
• Infectious Disease Physician • Transplant Pharmacist
• Intensivist • Transplant Surgeon
• Intensive Care Nurse • Ward Nurse
 YOU
DOCTOR

DOCTOR HEALTHCARE
PROVIDER
 Initiating the Process

• The first impression

• The first touch
• The first words
• The environment
• Clinic setting
• Ward setting
 Effective Listening

• Listening without interruption

• Obtaining clarification and acceptance
• Responding
 Obtaining Clarification

We may ask for information,….

….. but we are only interested in what

confirms our opinions.
Final Words
Final Advice
Make the patient your focus
Listen with your ears, heart and mind
Leave your distractions behind
Let the patients express
Hear what the patient says, not what you think
he said
Say the right things in response
The true measure of a DOCTOR is
the height of his IDEALS
the breadth of his SYMPATHY
the depth of his CONVICTION, and
the length of his PATIENCE.
Thank you

london.lucien.ooi.p.j@singhealth.com.sg