Listening is the single most important skill. 3 Listening is an active process, described by Egan as follows:
One does not listen with just his ears: he listens with his eyes and with his sense of touch. He listens by becoming aware of the feelings and emotions that arise within himself because of his contact with others (that is, his own emotional resonance is another'ear'), he listens with his mind, his heart, and his imagination. He listens to the words of others, but he also listens to the messages that are buried in the words or encoded in all the cues that surround the words. He listens to the voice, the demeanour, the vocabulary, and the gestures of the other. He listens to the context, verbal messages and linguistic pattern, and the bodily movements of others. He listens to the sounds, and to the silences. 4
Listening includes four essential elements:
• checking facts
• checking feelings
Listen with understanding, in a relaxed, attentive silence. Use reflective questions, such as:
• 'You seem upset about your husband.'
• 'It seems you're having trouble coping.'
• Modify language.
• Provide clear explanations.
• Give clear treatment instructions.
• Evaluate the patient's understanding.
• Summarise and repeat.
• Avoid uncertainty.
• Avoid inappropriate reassurance.
• Arrange appropriate referral (if necessary).
• Ensure patient is satisfied.
• Obtain informed consent.
• Be available for phone calls.
• Ensure patients obtain results of investigations ordered, including Pap smears.
• Ensure any promised follow-up is carried out.
• Phone the patient if you have any lingering concerns (this could be handled by the receptionist).
• Arrange referral if inadequate response to treatment.
• Act as an advocate if necessary, e.g. pressing for hospital admission.
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