Enhancing Patient-centred Communication in Medicine:

Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon),
FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine,
University of Colombo, Sri Lanka.
Joint Editor, Sri Lanka Journal of Child Health
Section Editor, Ceylon Medical Journal

In the perpetual but somewhat perplexing realm of healthcare, effective communication between healthcare providers and patients as well as the relatives and loved ones of our patients is paramount for delivering high-quality care and fostering positive patient outcomes. Central to this communication process are two verbs: “hear” and “listen”. However, while they are often used interchangeably, they denote distinct processes. These have significant implications for patient-centred care.

We must probe into the distinctions of these verbs and their critical roles in patient-provider interactions to complete the embroidery of useful communication. Such phenomena should be intricately woven into the tapestry of rapport with our patients and their family members. This is ever so important as it could form the unshakeable foundation on which mutually satisfactory communication portals are established between patients and healthcare providers. It generally is the vital force that promotes human-human interaction which is at the epicentre of optimal healthcare.

Understanding the crucial separation between hearing and listening is crucial to formulating satisfactory principles of communication. Hearing refers to the physiological process of perceiving sound waves through the auditory system; a kind of afferent input of thoughts and information. It is a passive, involuntary action that occurs without conscious effort. In contrast, listening actively totally transcends mere auditory perception. It involves dynamically paying attention to, interpreting, and comprehending the meaning behind the sounds or words being heard.

Listening requires intentionality, focus, and empathy, to facilitate true understanding of the speaker’s message and the ever so vital context of the words that are spoken. The curious paradox of hearing but not listening carefully is most unfortunately seen more often than not, even in medical consultations. Colloquially referred to as falling on deaf ears, such a phenomenon would destroy the all-important intellectual relationship with the patient.

The vital importance of listening in the context of healthcare is that listening holds profound significance for patient-centred care. When healthcare providers actively listen to their patients, they demonstrate respect, empathy, and genuine interest in understanding the patient’s concerns, preferences, and experiences. Active listening fosters trust, strengthens the patient-provider relationship, and enables shared decision-making, thereby and ultimately enhancing patient satisfaction and compliance with and adherence to the planned details of management of the illness.

Despite its undoubted importance, effective listening can be impeded by various barriers in healthcare settings. Time constraints, heavy workloads, and systemic pressures may undermine the providers’ ability to allocate sufficient time and attention to listening to patients. Additionally, language barriers, cultural differences, and emotional distress on the part of either the patient or the provider can hinder meaningful communication and hamper active listening.

Given the critical role of listening in patient-centred care, healthcare providers should actively cultivate and refine their listening skills by resorting to strategies that could enhance them. This would often need active efforts on the part of the healthcare personnel to develop it into a fine art. This can be achieved through training programmes, workshops, and ongoing continuous professional development initiatives focused on communication and empathetic listening.

Techniques such as reflective listening, paraphrasing, and non-verbal cues such as body language, facilitate deeper understanding and rapport with patients. Out of all these vital attributes, paraphrasing; a graphic form of communication whereby one reiterates in different words what someone says, holds pride of place as it very clearly demonstrates to the patient that the healthcare provider has been intently listening to what the patient was saying. Furthermore, creating a supportive organizational culture that prioritises effective communication and allocates adequate time for patient interactions is essential for fostering a conducive environment for listening.

While listening takes precedence in patient-centred communication, hearing too remains a rather indispensable and adjuvant component of a composite healthcare encounter. It plays a complementary and crucial role in the entire process of communication. Adequate and enhanced hearing abilities enable healthcare providers to detect connected but subtle cues, such as changes in a patient’s breathing patterns, eye contact avoidance, or changes in vocal tone, which may convey valuable diagnostic information. Moreover, for patients with hearing impairments or those with communication disorders, healthcare providers must adapt their communication strategies to ensure an effective exchange of information and promote inclusivity in care delivery. It is indeed a really fine art to be able to communicate with some of the people who are disadvantaged by their inability to hear or process what they hear.

It must even be reiterated that in the perpetually dynamic scenery of healthcare, effective communication forms the bedrock of patient-centred care. Pivotal to this communication is the crucial form of understanding the separation between hearing and listening. While hearing represents the passive reception of sound, careful and dedicated listening embodies active engagement, understanding, and empathy.

By honing their listening skills and recognising the value of both hearing and listening in patient interactions, healthcare providers can cultivate more meaningful relationships with their patients, promote shared decision-making, and ultimately, improve clinical outcomes. It is always most valuable and ever so important to listen carefully to what one is hearing through the special sense of the auditory apparatus. It may sometimes mean a lot more than what is received through the afferent acoustic pathway and the patients would absolutely adore healthcare personnel for their commitment and dedication towards their vocation.

The author acknowledges assistance from AI in formulating this article.