the power of listening

I’ve written a few times recently about how people with limb loss/disability might want to think about selecting a prosthetist if/when they have to make that decision. Specifically, I talked about the Holy Trinity (fit, components, and listening), as well as how to avoid the perils of assumed skill by association.

To close out this three-headed Hydra of posts, I want to turn today to an exercise I recently participated in that demonstrated the power of the Holy Trinity’s third element: listening to what the patient has to say.

I attended a seminar outside of Pittsburgh a few weeks ago. The event was held at an “airport hotel,” and I put that in quotes because apparently Marriott’s idea of what an airport hotel is and my grasp of the concept are entirely different.

In my world, an airport hotel is a hotel that you can get to in five minutes or less from – cue drum roll, please – the airport! I’ve seen airport hotels actually built into terminals in some cities. I’ve seen rows of them just outside the airport entrance in others.

But in Pittsburgh, apparently “airport hotel” means the hotel that you have to (a) pay $15-$20 to get to in a taxi, or alternatively (b) call on an airport phone that you wouldn’t know existed but for the kind airport security guard who doesn’t want to see you pay $15-$20 for a taxi, and who therefore leads you to the distant bank of phones where the person on the other end lets you know that the shuttle service will be there in 10 to 15 minutes. Upon climbing into said cab or shuttle van, you then exit the airport, enter an interstate, and drive. Some distance. You eventually exit the interstate, and continue on winding roads in the hills outside Pittsburgh, eventually entering an industrial park that, at its very end, contains your hotel. Which, by the way, isn’t located in Pittsburgh at all, but in the Borough of Coraopolis (birthplace of Michael Keaton).

Anyway, the purpose of visiting this “airport hotel” was to participate in a seminar, one part of which involves promoting effective communication between prosthetists and their patients. For the purposes of this exercise, I was the patient.

The exercise involved having prosthetists pepper me with questions in an effort for them to learn important facts that might help them treat me more effectively. (No, this wasn’t a personal casting call I set up to find the person who would treat me. I’m happily connected to a practitioner already. And I don’t want all of you flying into Coraopolis to hold American Idol-like auditions for America’s Next Great Prosthetist. So, to be clear, this was an educational event.)

I’ve gone through this exercise countless times before, sitting on both sides of the proverbial table. As the co-owner of my own practice, I was the one asking questions. And as a participant in these kinds of educational offerings, I’ve been asked questions by groups of prosthetists from around the U.S.

As the person being interrogated, I’ve become used to the familiar, repetitive, core group of questions that form the industry standard. “What would you like to do tomorrow that you can’t do today?” “Are you happy with your current prosthesis?” “What limitations do you have with your current prosthesis?”

You can see the prosthetists clicking through this regular list of queries with a reflexiveness that’s nearly as mindless as blinking or swallowing. There’s no thought behind the questions – just an unquestioned assumption that they’re the right ones to ask because, apparently, generations of prosthetists have passed them down to their successors since time immemorial. So I sit and answer them – “I don’t know,” “Yes,” And “None that I can think of,” are my responses, by the way – for several minutes, and then review the exercise with my friendly interrogators, pointing out what they missed and how they could have gotten more from me.

I have never been surprised by a question from a prosthetist during this exercise. I can tell you with 95% accuracy what the questions are that I’ll get long before walking into the “airport hotel.” The 5% I can’t foresee are generally questions that make little sense, so they get discarded on the trash heap without any real analysis. So it was with great surprise and, upon further reflection, delight, that I got a question from John in the Coraopolis “airport hotel” that stopped me in my tracks.

John had, apparently, been listening intently to what I had to say that morning, including information about my personal history. So in the midst of the average and ordinary questions that I can answer just as reflexively as the prosthetist can ask them, John dropped the following query on me:

Why did you leave the practice of law to open up a prosthetic facility?

And for a second, my mind went blank. It was like John had asked me a Zen koan designed to stop me in my tracks so that I could, for a split second, perceive the true nature of reality.

When the neurons in my brain started firing again, I blurted out, “That’s a great question,” and proceeded to give an answer that touched on the following themes: (1) changed professional priorities after my accident; (2) the desire to do something that was more meaningful to me; and (3) having the opportunity to interact with people in a more direct, profound way.

When I finished making those points, I did something I’ve never done – I stopped the exercise, even thought it wasn’t yet finished. I had to address the importance of John’s question before its impact was lost on me and the others in the room.

I pointed out to the audience that John’s question had no professional value to him. If John were my prosthetist, knowing the answer wouldn’t allow him to craft a better letter of medical necessity to justify a particular course of treatment. It wouldn’t get him information that might be useful clinically. And it certainly wouldn’t allow John to be more efficient in the operation of his practice – viewed objectively, the question was a waste of time (i.e., no useful information from a practitioner’s standpoint and forced him to sit through a lengthy response).

And yet, were I interviewing a prosthetist, this question would greatly influence how I thought about John as a potential provider of my medical care. I explained to the group that the impracticality of John’s question from a clinical/business perspective, in fact, was its greatest strength.

Say you’re at a cocktail party. You’re talking to small group of people, none of whom you know. You make small talk, commenting on the weather, traffic, and your job. If that’s all the information you exchange, chances are you won’t remember (or want to remember) any of those people in the future. You had a purely transactional relationship with them – an exchange of meaningless, benign pleasantries, because that’s what the general etiquette at cocktail parties consists of.

Now imagine you’re at the same cocktail party. But one of the people you’re talking to, as she listens to you spit out the same old lines about the “crazy winter” in the Northeast, the “brutal traffic” on the expressway, and your work at Company X, starts asking questions that go beyond the banal. She wants to know how you got into your line of work. She’s interested in understanding decisions you’ve made. Most important, the questions she asks you show that she has been listening to everything that comes out of your mouth. What’s your reaction to that?

(For my male readers out there, I know how you think. And no, the answer is not that she finds you irresistible and is angling for an invitation back to your place after the cocktail hour. None of us are as charming, good-looking, and charismatic as we think we are. Especially after a few drinks at a cocktail party. So get over yourselves and think about the deeper answer.)

Your reaction – once you men filter out the considerable noise created by your sex drive – is that this is a person who, despite meeting you only a short while before, cares enough about you to ask thoughtful, serious questions that allow you to reveal a little something about yourself (if you accept that invitation). This is the kind of person who, after the other people in the group have left to mingle with others at the party, you keep talking to and asking similar questions of her (if you’re sober enough to display the same skills she did) because now you want, and maybe even need to understand what makes her tick.

In short, to return to a recurring theme of less is more, this person is giving you the opportunity to tell your story. And stories are powerful things.

John’s question, I explained to the group, had power because I couldn’t trace it back to any kind of agenda that would actually help him. In the absence of clinical value, in the absence of insurance claim-related value, the only conclusion I could come to was that John asked the question for no other reason than he was interested in the answer.

In a world of transactional relationships – and I’m sorry folks, the relationship between you and prosthetist is transactional, even if you don’t think it is – this is a huge (and positive) departure from protocol. Even today, I know very little about John as a practitioner. I don’t know anything about his patients, his philosophy, or his patient outcomes. But I do know that John has a rare talent: he actually listens to what people are saying. And the resulting questions he asks signal to the person he’s talking to that he cares about their story.

For the average person, this is a nice trait. But for people with LL/D, I think it’s even more significant. When you lose a limb or have a limb difference, you spend a significant part of your life figuring out how to address it. Maybe you ignore it. Maybe you wear it like a badge of honor. Whatever path you choose, you are implicitly crafting a narrative about who you are. However, you rarely get a chance to tell your story on the proverbial blank slate.

When your prosthetist shows you, by listening, that she cares about your narrative – even when the facts won’t make it into her patient notes or help her process your claim – she is giving you the chance to tell your story your way. That’s highly unusual. It requires the prosthetist to sublimate her business to your narrative. That’s not an intuitively intelligent way to operate a facility. There’s not one short-term metric that would provide a compelling case for asking questions and getting answers that have nothing to do, on their face, with your care and treatment. But I think there’s an intangible, long-term benefit for both the prosthetist and for you if she does listen and ask these kinds of questions.

Now, at the same time I sing John’s praises, I need to put this all in appropriate perspective. The ability to listen is only one-third of the Holy Trinity. A prosthetist with fantastic listening skills but who can’t fit you and who doesn’t understand prosthetic components isn’t the person you should aspire to have make your prosthesis. I would never select a prosthetist based upon listening alone. I’d have to see some evidence of excellence in the other two areas as well.

At the same time, though, give me a prosthetist with world-class socket skills, unsurpassed knowledge about the components he’s fitting, but not a care in the world for what his patients have to say, and I’ll shoot out of that facility faster than Lindsay Lohan out of a jewelry store. (In other words, really fast.) That is a miserable patient waiting to happen.

I would like to end this post by letting John know that, upon hearing his question, singing his praises in front of the group, and deriving a whole post from him, I have not once, not even for a split second, misinterpreted his query to mean that (a) he thinks I’m irresistible, or (b) he wanted me to ask him out on a date afterwards. (My wife will, no doubt, be relieved to hear this. John probably will be as well.) But I’d like to thank him for reminding me that I can be surprised, even when I least expect it.

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