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Listening---We Do Not Hear. A Danger Situation for HCPs
by Bob Blumm, MA, PA-C, DFAAPA - March 29, 2010
I occupied myself an hour before retiring tonight by reading a book on silence. The manuscript caused me to reflect on the sounds that follow silence and I began to type this “written word.” When I was a child, I grew up in Queens, which is one of the five boroughs of NYC. My very small back yard was fifty yards from what was called “an elevated line,” which is a train track that is approximately three stories tall; it travels many miles from Brooklyn to Queens. When I initially moved to this area, I was awakened by the sounds of the train passing my home every ten minutes. Within a short period of time, I no longer heard the sounds of the passing trains and slept “like a baby.” Strange, how I had never realized this prior to tonight.
As a young man serving in the US Army in Vietnam, I was exposed to the loud explosions of enemy mortar, our own artillery, Air Force bombs being dropped near our positions, the sounds of small arms, machine guns and hand grenades. I was exposed to such a degree that I now have impairment of my upper levels of hearing. I was so tired one night that I slept through a rocket attack, never going to the protected area. My dog was wounded, as she slept at the foot of my cot, from shrapnel. Once again, I had learned to endure sounds and to block them from disturbing my sleep.
Ten years later, as a young married man and a new father, surprisingly, I could always hear the cries of my children; I did not necessarily hear the comments of my wife. One evening, as she spoke to me I was responding with some type of noncommittal grunt, and she asked the question, “What did I just say?” Terror of sorts confronted me as I knew she had discovered that I was just humoring her. I was hearing but not listening. Incidentally, and with some timeless irony, she now does the same to me. The SP surgeons, with whom I have operated for the last 38 years, play loud rock music in our room during surgery, and of course, true to form, I have shut off my hearing and couldn’t tell you if I listened to a male or female, no less which group.
The ability to hear without listening is a great art. It is one that is not consciously practiced but yet provides us with some solitude. The problem lies in that we have become so manipulated by this phenomenon that we have incorporated it into our presence at conferences, classes and places of spiritual worship. We have become hearers but not listeners, and this is dangerous ground for the PA or NP. Why? Because we are responsible daily for listening to our patients and, unless we use the power of concentration, we can lose the message that the patient is trying to communicate. We can miss the diagnosis. Or we can lose the special moment of illumination that enables us to read between the lines as a patient speaks and gives us a new insight that may alter our treatment plan.
My sincere message for this week is that you ask yourself whether you have applied this same coping mechanism for scenarios in your life. Then ask others or seek, through your introspection, whether you are missing valuable information that is being communicated by your patient. The danger will lurk when you have a particularly chatty patient or one that resembles individuals that you have managed to avoid listening to in the past. Our responsibility is to sum up the history by careful listening habits as well as by examination and apply these skills to reach a diagnosis. There may need to be some retraining in your life. But this is a positive move in that there will come a time in our lives where we will hunger and thirst for the words that we so conveniently shut out , when the speaker of the words no longer breathes the same air or occupies the same space. This can become reality in the moving of your children or the death of a spouse. As you see, a reflection on silence can yield its fruit by creating an appreciation of both hearing and listening.
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
So true! I had a pt in UC who was on 3/3 chart for migraines. Of course, here he was sitting in the dark room with sunglasses saying demoral is the only answer. I listened to him as I questioned him of his symptoms. Knowing he has a neurologist and his GP asking all the same questions, I didn't want to let my judgement of drug seeker get in the way so I drilled. After getting a full hx, I realized he had cluster headaches and got oxygen on him. After forgetting about him and returning 30 mins later, I found him with the lights on, color in his cheeks and laughter. The oxygen helped. I had listened and he was better. The next day, his GP found me and told me he had O2 on order and that he spent years not listening to this man.
Thanks for the reminder.
