How listening can impact you and those you serve
By Ellen Schmitt, PT, DPT
On every clinical rotation during my time in physical therapy school I made it a point to ask as many patients as I could one of the following questions:
“What is one piece of advice you’d give to help me become a good physical therapist?”
“What is one thing that has made your physical therapy experience a great one?”
Time and again, the most common response I received involved taking the time to listen and listening well. It seemed listening was the key determinant between a bad physical therapy experience and a good one, a good one and a great one. Think of someone who has had a significant impact on your life or someone you admire. If you had to list the positive qualities about the person who came to mind, what would they be? Somewhere on the list, I’d bet something along the lines of “good listener” is there. When I think back to some of the most challenging and the most rewarding experiences I’ve had with patients over the last few years I cannot help but be grateful for the time I took to listen to their stories. Not only has it made me a better physical therapist, but it has also made me a better person. Yes, to some degree, we’re required to listen to our patients. We ask them how they’re feeling, why they’re in physical therapy, and what they want to accomplish. However, whether or not we actively or passively listen to their responses is a personal decision we must make each day.
When I was a student, I helped treat a young gentleman with an acute, traumatic brain injury. He was often irritable, agitated, and violent during our physical therapy sessions and very hard to reason with. He couldn’t tell us how he was feeling or what exactly he wanted to accomplish at all. One day, his parents attended his physical therapy session and I listened to stories that revealed more about who this patient was before his accident. I listened and I learned he liked music. During our next physical therapy session, this patient became overwhelmed with a task he couldn’t do and started to lash out. In the midst of his fit, I remembered what his parents had said about music and so I asked the patient who his favorite artist was to distract him. He yelled, “Post Malone!” but promptly went back to kicking and screaming. One artist, one response, that was all I needed. I immediately grabbed my phone and pulled up my Spotify. Within seconds his shouts began to subside as the lyrics to Post Malone’s “Circles” filled the air and we all took a moment to enjoy — to listen. Had I not been paying attention to this patient’s parents the previous day I may have missed the opportunity to communicate with this patient in a way he understood and enjoyed.
During another clinical rotation in school, I encountered a patient whose story was all too familiar. This patient shared she had bounced around from clinic to clinic for months and was frustrated with how her physical therapy, and overall healthcare, experience had been. She felt nobody cared about what she had going on and felt her doctors just wanted to push her to medications or surgeries or onto the next provider. My clinical instructor (CI) and I spent a good chunk of our hour-long session just listening to this patient share her story. After the patient left, I asked my CI how I was supposed to bill for the session given we didn’t get started on what I believed to be the “real stuff” until later in the hour. My CI told me that while it’s important not to waste the time we get with patients, it’s important to allow time and space for patients to share their stories even if it takes a little longer than we might hope. I remember listening to lectures in school about the importance of treating the “whole person” and how my professors would stress the importance of doing exactly what my CI was telling me to do. My CI explained that apart from it being a good thing to do, taking the time to listen also helped to build a strong foundation for the patient-provider relationship and would pay off in the long run. She said that once you listened you would more easily gain the patient’s trust and would likely have an easier time getting the patient to listen to you in return. I recently saw that patient again and she told me our clinic’s providers were some of her favorites she’d ever worked with because, “You listened; you actually listened to me.”
Recently I was reminded of this lesson from my CI in an interaction I had with one of my own patients. During our first few sessions I found it difficult to strike up and carry conversation with this patient. She always had polite responses but seemed more content to work in silence. I know not everyone enjoys talking during physical therapy or at all for that matter, but I like to try and engage the people I’m working with. At the very least, it helps the time go by a little faster. While I didn’t feel the need to push her into conversation, I consistently asked this patient what her plans for the day or weekend were and always got the same response — “women’s small group.” One afternoon I asked her to tell me more about what she was studying in her group and found I had hit the conversation jackpot. From that point on this patient came to our sessions with a much more positive, energetic attitude and was willing to participate more than I thought she had been capable of. Why? Because she was excited to share more about what she had been reading with me while we worked. Despite our best efforts, several weeks of therapy weren’t getting us the results we had been hoping for and I encouraged her to return to her physician’s office to discuss what options may be more appropriate. I felt I had failed this patient and I could tell she was discouraged. On this patient’s last day though, she came in with a sweet thank-you note and told me how grateful she was for our time together because of the opportunity it gave her to talk with me and not just talk at me, to be listened to.
In every scenario I reflected on above, taking the opportunity to fully listen instead of simply asking the questions without processing the responses added to the “success” of the patient-provider interaction. No, it didn’t guarantee direct success from a physical standpoint, but it did help with the patient buy-in process. While the technical skills and knowledge of anatomy, physiology, etc. are important to being able to provide high-quality care, the interpersonal skills one possesses are arguably the skills most crucial to providing the best care. Those skills can easily be pushed to the side though with the pressures of productivity, insurance, time constraints, people to see, and places to be. Those pressures can cause us to see the patients who come through our doors as just another number, another unit, another paycheck. However, the core values of our profession — accountability, altruism, collaboration, compassion and caring, duty, excellence, inclusion, integrity, and social responsibility – should drive us to see these patients as the unique individuals they are and should inspire us to listen to them. In doing so, we are bound to become better teachers, students, co-workers, and friends not just for the sake of our profession but for the sake of our world today.
Not only have I gained a lot from listening to those around me, but I have gained just as much from being listened to. I’m grateful for my parents who have listened to my dream of being a physical therapist since I was in middle school and who have helped push me to be where I am today. I’m grateful for my friends in college who listened to me worry about whether or not I’d make it into physical therapy school and gently reassured me things would be OK. I’m grateful for my roommate in grad school who listened to my rambling thoughts and stood by my side through numerous failures and sweet victories. I’m grateful for every clinical instructor, professor, and co-worker who took the time to answer my questions and offer advice as I transitioned from volunteer to rehab tech to student to physical therapist. I’m grateful for the people in my corner today who allow me to vent and brag and talk their ears off about this profession I love. For these people and so many others, I am thankful because although it may seem small and simple, the act of listening can make much more of an impact than we realize.
Ellen Schmitt, PT, DPT, is a physical therapist who is currently practicing in Cincinnati, OH at Premier Physical Therapy Services. She can be reached at firstname.lastname@example.org.