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May 2003

Learning to Listen

Arch Pediatr Adolesc Med. 2003;157(5):414-415. doi:10.1001/archpedi.157.5.414

THE ABILITY to listen is arguably the most important clinical skill in medicine. Ask any person the question, Based on your personal experience, what quality do you most associate with physicians you consider "good," and what quality do you most associate with physicians you consider "bad?" The top response is: the "good" physician is one who listens; the "bad" physician is one who is inattentive and rushed.

The teachers most sharply etched in my memory are those who tried to imbue attitudes on how to approach patients or those who modeled ways of communicating with children and their parents. A few examples that come to mind of such teachers are: Randolph Byers, a neurologist at Boston Children's Hospital who was known to say: "Neurologists don't do much to alter the course of an illness. We mostly help families adjust to the terrible things that have befallen them." Rudolph Toch, an oncologist also at Boston Children's, who demonstrated long periods of silence and sympathetic listening when sitting down with the parents of a newly diagnosed cancer patient; Donald Winnicott, a pediatrician-psychiatrist at St Mary's Hospital, London, England, who to avoid confrontation would sit in a child-sized chair at the child's side rather than face-on; and Michael Rothenberg, another pediatrician-psychiatrist at the University of Washington, who stressed "listening with the third ear" to pick up clues from voice inflections and body language. In pediatrics where we spend a relatively large amount of time with healthy patients, and where so many of the illnesses we treat are self-limited, communication skills are especially important. We perform relatively few procedures. What we mostly "sell" is our advice.