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Listening Up and Leaning In


As a brand new, inexperienced first year medical student, I took the required patient interview course. Actors were hired to portray patients with a variety of medical conditions. On my first day, dressed in my short white coat, notebook in hand, I entered the exam room.

“Hi my name is Dr. Anthony (I was a young, single student at the time),” I began. “What brings you into the office today?”

As soon as my patient began her story, I started to formulate my next question while anticipating her possible responses. I heard everything she said, evidenced from the copious notes inked in black on the pages in my hands. But, I really didn’t listen to a word she said.

Over the years, I have learned the importance of active listening. As a student, I focused on hearing my patients’ account of their illnesses, allowing me to gather pertinent details. Active listening serves the additional tasks of helping the listener gain understanding and trust. I have come to realize that in most circumstances, how the patient experiences our interaction is as important as what he or she tells me. While my training taught me how to gather details, it did not teach me the practice of active listening.

Active listening is good for the speaker’s brain.

Studies suggest that the brain’s reward system is triggered during active listening. In a 2015 study published in the Journal Social Neuroscience, researchers selected 22 participants to who were video recorded reading essays they wrote about a variety of their life experiences. Evaluators, actors hired for the study, were instructed to view these videos showing behavior with or without active listening. In a second session, researchers conducted functional magnetic resonance imaging (fMRI) on participants while they viewed the evaluators assessing their video clips. In addition to rating evaluators who showed active listening more positively, participants rated episodes where evaluators showed active listening more positively. The results also showed enhanced neural activation in both the ventral striatum and the right anterior insula when active listening was perceived. These areas are associated with motivation and reward. Both results suggested that the active listening process was rewarding.

Active listening helps create a safe place for patients to reveal intimate thoughts and concerns.

Active listening allows us to gain a deeper understanding of our patients. When we understand our patients, we gain insight into their complex lives. We begin to see beneath the layers of his or her narrative to the real story. When we give our full attention to a person, we are able to maximally receive his or her message while decreasing the interfering “noise”. The noise is all of those activities our brains engage in when we are not listening to the person who is speaking. With active listening, our focus centers on knowing another instead of being known. A patient labeled as non-compliant for not taking his medication becomes a patient who, after losing his job, is too depressed to get out of bed in the morning and muster the energy to take his medication.

When we build trust with our patients, they find comfort and safety as they reveal their concerns. We trust that what they are telling us is their best understanding of the what they are experiencing. We are not imposing our agenda on them and are able to receive what they have to share with us. Of course, there are times when our agendas are important as certain details must be clarified and understood to allow us to do our jobs. However, active listening helps us forge more holistic relationships with our patients giving us a clearer picture of the individual sitting across from us.

With intention and practice, active listening helps us become attentive and receptive to what another has to say. Your own emotions might shift in response to what is being shared. You will know another person in a way that you didn’t previously, increasing your capacity for sitting in his or her experience or emotions. Active listening engages empathy.

Do you practice active listening?

How good of a job are you doing at bringing active listening into your conversations? The American Listening Association suggests asking yourself these questions to understand whether or not you are engaging in active listening:

  1. Are you giving the speaker 100% of your attention?

  2. Are you listening to understand, rather than listening to respond?

  3. Have you opened your mind to receive what is being said?

  4. Have you rejected the temptation to prepare your response while the other person is speaking?

  5. Are you open to changing your mind?

  6. Are you aware of what is not being said as well as what is being said?

  7. Are you taking account of the degree of emotion attached to the words?

  8. Are you aware of any differences, and similarities (such as culture, age, gender) between you and the speaker which may influence how you listen?

  9. Are you giving signals to the speaker that you are listening?

  10. Are you valuing the speaker and the experience they have gathered in their life so far?

Active listening is an important tool in every doctor and therapist’s toolbox. It can help facilitate more trusting and deeper therapeutic relationships. In our professional and personal lives, active listening can lead to more connected and rewarding interpersonal interactions allowing us to experience even greater fulfillment.


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