Listening.

How often do we stop and listen? To ourselves? To each other? To the world? Just listen. 

When I stop to listen now, I can hear the water running through the pipes. I can hear the typing of the keyboard. Occasionally I can hear a dog bark outside. If I listen very closely, I can hear spatters of rain on the window. A crow just cawed. I hear another sound- I am really not sure what it is… sounds like it could be the boiler maybe? Or the fridge? Is it the plumbing? I recognize this sound- I know I have heard it before. But I have never actually sat and acknowledged it was there. It is pretty loud. But what exactly is it? How am I going to find out what it is? Now I am curious. I am going to ask. 

I have just asked my mum. She reckons it’s the pipes coming down from the attic. The more I sit here and type, the more aware I am of it.

Now I have asked my dad. Apparently, the pump for the solar panels are more or less above my head. He reckons it might be that. Along the same lines as my mum but a little different. Two different options to what the same noise could be. But I still I wonder what it actually is. Are they right? Have we interpreted it correctly?

I can definitely also hear my thoughts. They are pretty loud. But I want to listen to what is going on in this room, in this world. My thoughts aren’t what is important right now as I am trying to understand what is happening outside of me. 

Listen. Ignite your curiosity. Ask. Investigate. I am so drawn to the word curiosity recently. Be curious. Always. But is asking enough? I am still not confident I understand exactly what that noise is. But I have a better idea. I am fairly sure it’s not dangerous and not something that is a threat to me. I am fairly confident in that because I have asked, listened and clarified to an extent. But I am still not 100% confident in the definitive answer- what exactly is the noise.

So when I listen to a client, and I am not fully sure I have interpreted their words, do I feign understanding or do I unleash my curiosity? There have been times that I have been afraid to ask questions for fear it will expose my lack of knowledge and my vulnerabilities. Particularly with clients- if they thought I didn’t know something would they lose their confidence in me? Or would they be happier in knowing I am as informed as I could be. Does showing curiosity help the rapport, and to show I care? 

If I hear something, and I am of it’s interpretation, isn’t it so important that I ask about it? Delve deeper into it. Use my curiosity to explore, gain knowledge, gain understanding. How can we expect to help if we do not understand, if we are not aware. Can I ever be sure that I understand unless I clarify? Will I even be positive then? Maybe not but I will be a lot better off than if I had not clarified at all.

I saw a post recently that went like this “Doctor: ‘Don’t confuse your google search with my 6 years of medical school. Client ‘Don’t confuse your one hour lecture on my condition with my ten years+ of living with it.’”.  How accurate. Who really is the expert here? Who do we have more room to learn from? Who can tell us how to help them? Who can tell us what it feels like to have this condition? Who can tell us what it means to them to help them back to sport, or running? Hippocrates once said many thousands of years ago- I would rather know the person who has the disease than the disease the person has. For me it still rings true.

Are we listening to a knee? A hip? A pelvic floor? Or are we listening to a person? I would argue the knee/hip/pelvic floor or whatever the body part might be, will give us information. But isn’t the interpretation of it all the more important. 

Nociception is neither sufficient nor necessary for pain- a beauty from Jilly Bond that has completely changed the way I look at the pain cycle.

So, if we’re not just looking for nociception, how else can we understand this person? How about communication and listening? I had 2 modules on communication in University. Over 4 years- 2 modules on communication and one was completely theoretical. I talk a lot. Quite often my mouth moves as quick as (sometimes I think even quicker than) my brain.

But how often do I stop and listen? Definitely not enough.  

I would have scored very high in communication while on placement in University. In all 6 placements I reckon communication would have been my strongest area and I would always have considered communication as one of my strengths. Now I am beginning to question that. What did they classify as good communication? Discussions with my supervisors and clinical educator, letting them know when I was out of my depth and needed assistance. Being able to chat with other health professionals and patients easily. Is this good communication? Or is it an outgoing personality? I would argue they are very different? Communication goes a lot deeper than being able to open up a conversation.

I often found it difficult to get a good rapport and alliance with my patients in Singapore. I found they were not very open in their stories and would generally give one lined answers (A generalisation for sure but something I definitely experienced or felt). I think this may be down to a difference in culture and upon reflection, is something that I really struggled with. I ended up resorting to an interview style subjective examination. Literally for the purpose of filling in the form. Was I listening to them? No. Not how I should have been anyway. I was asking the wrong questions. I was leading them. I wasn’t allowing them to give me their story. I found it difficult to set meaningful goals. My line of questioning was inadequate.

When I moved back to Ireland, I found it was the exact opposite. Irish people love to talk. Often I found clients were coming to see me because they enjoyed the chat. I was interrupting people because I had my list of questions to get through. I could hear them, but what else could I hear? My own thoughts. My burning questions I needed to tick off the list. But was I listening? Was I really hearing what they had to say. Was I looking at this person as a whole? By interrupting, was I causing harm? Was I making that person feel once again, their story wasn’t being listened to? 

The power of stopping to listen.

Just the other night I was sitting out the back garden. I heard a bird. I stopped and listened. I realised it was a seagull. I live close to the coast, but not very close. Was there rain coming? I went inside. Not long after, the rain came. 

The power of not only stopping to listen, but interpreting what you hear.

I have started to stop. And to listen. To ask questions- only when appropriate. Not when I feel like it. I don’t interrupt. I listen. This is a work in progress. It is always something I will have to work on. And everyone has something different to say. So listening will never stop. The day it stops is the day I think I understand it all. I don’t understand it all, and I never will.

But what happens if you do listen and you don’t interrupt and all of a sudden, the session is over and you haven’t actually done anything. What use was that? I now would argue that that session may have been the most beneficial of the lot. I always used to believe that we needed to give the client something to go home with. Exercises. Hands on Treatment. Something to work on for the next week. But what if what we have given them, was all the more valuable- a listening ear. How powerful can it be to have someone walk out that door and feel like they have been listened to? To Feel like they have been heard? How can we underestimate that power? 

How do I treat people? How do I help people? Is it with “magic hands”? Or brilliant rehab skills? Or is it with a listening ear? Piecing puzzles of the jigsaw together with people. Understanding where someone is, and where they want to be and figuring out their path to get there? 

I often talk out of a lack of confidence. Almost like I am trying to convince myself as much as the client. Telling them a story so I can make sense of it as well. I am becoming more and more comfortable with silence. Recently I have tried waiting 6-8 seconds before jumping in. I find it’s long. It’s uncomfortable silence. But is that a bad thing? Is silence better than interruption, or telling a story to fill a gap? Is filling that gap harmful, and diminishing the client’s thoughts, emotions, beliefs? Potentially, yes! 

I used to come home from work and say that I was tired of hearing my own voice. This is something that I don’t want to have to say. What is the benefit of hearing my own voice? I should be listening to the clients. Needless to say there will be an element of educationa dn explanation from me, but how can I do that if I haven’t listened? If I haven’t asked? If I haven’t clarified or understood what exactly it was that I heard?

What is that loud noise that I am hearing here in the room? All of a sudden I can hear it again. The sounds of my own thoughts had drowned it out. Like I said it is something that I have to work on constantly and continually. But I look forward to listening. To hearing. To learning. And to growing. The absolute power in listening.

Hippocrates also said to “Make a habit of two things: to help; or at least to do no harm”. And the question I pose to you is  “Can we do harm by listening?”

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