The Art of Listening in Medicine Is More Than a Skill. It’s a Necessity

Adopting practices related to narrative medicine facilitates good listening.

I met up with a relative whom I had not seen in a long time. Our conversation turned to medicine.

“You don’t need to be a genius to be a doctor,” I told him. “You just need to know how to listen to your patients.”

My relative, who is not a physician, added: “Patients need reassurance. They need friendly faces. They need receptionists who are actually receptive. They need angels of mercy. Furnishing these special features requires the sort of humility capable of appreciating that a healthcare system needs its patients as much as the patients need the system.”

We agreed that in the fast-paced world of modern medicine, where technology and innovation drive much of the diagnostic process, doctors are losing the fundamental skill of listening to their patients.

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Listening is the essence of effective clinical practice. Listening is more than just hearing words; it involves understanding the emotions, concerns, and contexts behind what a patient is saying. It’s about creating a space where patients feel safe to express themselves fully, which can lead to more accurate diagnoses and better therapeutic outcomes. Here are some clinical examples that highlight the importance of listening in medicine:

1. The Case of Unresolved Symptoms: A 45-year-old woman presented with chronic headaches that had been resistant to various treatments. Multiple specialists had assessed her, focusing primarily on pharmacological interventions. During a consultation, a psychiatrist took the time to listen to her story in detail, allowing her to describe her daily life, stressors, and emotional state. It was through this empathetic listening that the psychiatrist discovered her headaches were linked to severe anxiety stemming from unresolved grief. By addressing the underlying emotional issue, the patient experienced significant relief from her symptoms.

2. The Misdiagnosed Condition: A young man was diagnosed with irritable bowel syndrome (IBS) after presenting with gastrointestinal distress. However, his symptoms persisted despite treatment. A physician who practiced active listening noticed the patient often mentioned his symptoms worsened with certain life events. Through careful listening and questioning, the physician uncovered that the patient had a history of celiac disease in his family, which had been overlooked. Subsequent testing confirmed the diagnosis, and with dietary changes, his symptoms improved dramatically.

3. Building Trust with a Reluctant Patient: A teenage patient with diabetes was frequently missing appointments and not adhering to her treatment plan. Instead of reprimanding her, her physician decided to listen attentively to her reasons. The patient revealed her fear of needles and a feeling of alienation from her peers due to her condition. By listening, the physician was able to address her fears, arrange for alternative insulin delivery systems, and connect her with a support group. This approach helped improve her compliance and overall health.

4. Addressing Cultural Sensitivities: In a multicultural society, understanding a patient’s cultural background can significantly affect care. An elderly patient from a non-Western culture was experiencing unexplained weight loss and fatigue. By listening to the patient and her family, the physician learned about her dietary habits and cultural practices. This understanding led to a culturally sensitive care plan that respected her traditions while addressing her nutritional needs, resulting in improved health.

Listening is an indispensable tool in a physician’s repertoire. It creates trust, uncovers hidden diagnoses, and leads to more personalized and effective patient care. As technology evolves, the human touch provided through attentive listening remains irreplaceable. By mastering this art, physicians can ensure they not only treat diseases but also heal patients in the truest sense.

Mastering the Art

To master the art of listening, physicians must cultivate a set of deliberate practices that prioritize patient-centered communication. This begins with creating a welcoming environment where patients feel comfortable sharing their concerns. In the case of my relative, this did not happen.

He said that in order to make eye contact with his physician, he had to turn his neck 45 degrees. When the doctor tapped on their computer, computerized notes were helpfully projected onto a screen on the wall — but viewing them required him to turn his neck 90 degrees.

When he mentioned this complication to his doctor, the physician invited him to move to a less comfortable (and also immobile) bench in the corner, where he could view the doctor (albeit from a greater distance) without turning his head but could not view the screen on the wall without craning his neck by 180 degrees! “I was beginning to feel like Linda Blair, doing her full 360 in The Exorcist,” he said.

Once patients are comfortable in the exam room and physicians feel unencumbered by technology, they should practice active listening techniques, such as maintaining eye contact, nodding affirmatively, and minimizing interruptions. This signals to the patient that their words are valued. Reflective listening, where the physician paraphrases or clarifies what the patient has said, can also be beneficial, ensuring understanding and allowing patients to expand on their thoughts.

Additionally, physicians should be mindful of their body language and tone of voice, as these nonverbal cues significantly affect patient perception. By being fully present and attentive, physicians can pick up on subtle emotional cues and underlying issues that might otherwise be missed. Regularly seeking feedback from patients and engaging in self-reflection can help physicians continually refine their listening skills.

The Practice of Narrative Medicine

I recommend that physicians take up the practice of narrative medicine, which enhances empathic listening by encouraging them to view patients’ stories as central to the healing process. This approach emphasizes the importance of understanding the narrative context of a patient’s life, which includes their personal, familial, and cultural backgrounds. By engaging with patients’ stories, physicians can develop a deeper empathy and appreciation for their experiences.

Narrative medicine training often involves exercises in writing and reading, which help physicians process their own experiences and biases and generate a more open and empathetic mindset. This practice not only aids in understanding the patient’s perspective but also helps build stronger therapeutic relationships, as patients feel heard and understood on a more personal level. Ultimately, narrative medicine bridges the gap between clinical expertise and compassionate care, enriching the doctor-patient interaction through shared stories and mutual understanding.

While recounting his story, my relative reminded me that his doctor’s visit occurred in a new state-of-the-art building resembling a modern Eiffel Tower. “Surely it doesn’t cost $762 million to teach employees to listen?” he asked incredulously.

Excerpted from How to Jumpstart Your Medical Career and Thrive in Practice: Practical Advice and Insight from a Battle-Tested Physician (American Association for Physician Leadership, 2025).