How do we choose the people that we are seeking help from, particularly when it comes to our health? I can only speak for myself and my 15-plus years of experience with patients as a physical therapist. When it comes to what I am looking for, it is whether this clinician is present in the moment, are they actively seeking to understand what it is that I want to attain from their expertise via listening and salient question asking, and are they able to provide insight and guidance on what I will need in the future. In short, are they focused and present, are they seeking to understand the situation fully by listening, and do they have a plan in place?
Things that will disqualify a healthcare provider from a patient seeking their help include no focused attention and no listening or questioning for clarification, just an automatic dive into telling or selling. This criterion can even apply to when choosing a partner to date or when hiring a prospective employee! Regarding providing healthcare, as the person providing guidance, we can organize our actions much more quickly if we take the time to listen and understand what the patient is seeking. Common sense, right? The problem is that it is not as common as you think, and the lack of it costs those seeking help in achieving their best outcomes. The inability to listen effectively is not just another added service expectation. It is a primary clinical intervention.
Listening Is Not Passive. It Is Diagnostic.
Today’s modern healthcare obsesses over protocols, modalities (every piece of equipment that is supposedly a game-changer), and metrics. Unfortunately, what continues to be glossed over, but is the gateway to all these components, is the act of listening. The clinician who listens well — and asks the right questions — produces better outcomes. Berry et al. in Mayo Clinic Proceedings argue that listening is both a value and a value-creator. When clinicians interrupt early or mentally jump to conclusions without fully seeking to understand the patients’ issues, not only how their health problem came about, what makes their symptoms worse or better, or how their condition currently makes them feel physically, but also how their lives are affected. Healthcare providers who do this not only miss the information that could provide a breakthrough in relieving the patient’s pain, but also reduce the patient’s trust and reaffirm their own cognitive biases about what they think the issue is, without having all the information. This often leads to treatment visits going down the wrong path, further wasting time. You could say that listening improves diagnostic precision and reduces unnecessary interventions.
Pain Patients Don’t Just Need Treatment. They Need Validation.
Treating someone for injury is rarely just providing treatment without acknowledging what the patient has going through, empathizing with them on how they got to this point, providing constructive feedback to make improvements and changes, or cheering them on when their desire and effort yield a win for the day and possibly the week if the right thing has been performed. The ability to do all those things does not occur if one is not listening carefully to how the patient is feeling without a hint of judgment.
Haverfield et al. found that patients with chronic pain repeatedly report feeling dismissed, judged, and not believed. I’ve seen those feelings resonate early on when a relationship between therapist and patient is just starting to develop. At the end of the day, the patient wants to know that you understand that they don’t want to be in their current state and that you are there to support them as an individual, not just another patient. Those feelings can arise and fester if your healthcare provider is not listening to the patient’s language, both verbal and nonverbal, and just plows through telling them what they need to do, regardless of receptivity. Having the patient identify which areas they would like to improve and how they think that will be best achieved, through timely questioning, can be the difference between whether they engage with and adhere to treatment or not. Bottom line is that the identification of asking questions does not occur if the healthcare provider is not mentally present and listening during each session. An opportunity for a breakthrough in treatment is missed without this very important clinical intervention.
Motivational Interviewing: Structured Listening That Changes Behavior.
Motivational interviewing is a patient-centered communication style that we use to help patients change their problematic behaviors by exploring and resolving their resistance to change in a non-confrontational manner. It has been shown to empower patients to increase their autonomous motivation not through advice-giving but through autonomy-supportive questioning, such that change arises from within the individual rather than being imposed by others.
An example of this would be a patient stating, “I know I should exercise, but I don’t have time.” The health care provider would affirm the patient’s statement with: “You value your health, but right now it feels overwhelming.” But would then strengthen the idea of commitment to lead to actionable change by asking, “If you did have time to exercise, though, how would that change your life overall?” The patient is led along a gradual path to act on the positive effects of exercise, as affirmed by the patient’s observation.
The methodology has been used successfully in people who smoke, have addiction problems, have eating disorders, and in diabetes management. The BMJ meta-analysis by Zhu et al. confirms that motivational interviewing improves physical activity outcomes, albeit only for up to 1 year, but that would be plenty of time to get a patient out of pain and back to their preinjury way of life. The ability to implement this system only comes about from focused attentiveness and listening with your eyes and ears.
Why This Matters in Musculoskeletal & Pain Care (Especially for You)
The right questions at the right time can make a huge difference in whether a patient can see through the trees of mental obstacles and reach the clearing where exercise and treatment take place to remove pain and return to preinjury life. Your desire to choose healthcare providers who consistently pay close attention and listen fully is just as important, if not more so, than finding a practitioner with the best technical skills. Fortunately, we remain committed to improving and staying on top of both areas. If you made it this far, thank you so much for your time! We appreciate you. Reach out if you need, and stay well and active, Mobile Spine Family!
References:
Berry, L.L., Bisognano, M., Twum-Danso, N.A.Y., Awdish, R.L.A., 2025. The Value — and the Values — of Listening. Mayo Clinic Proceedings 100, 1482–1486.
Haverfield, M.C., Giannitrapani, K., Timko, C., Lorenz, K., 2018. Patient-Centered Pain Management Communication from the Patient Perspective. J GEN INTERN MED 33, 1374–1380.
Zhu, S., Sinha, D., Kirk, M., Michalopoulou, M., Hajizadeh, A., Wren, G., Doody, P., Mackillop, L., Smith, R., Jebb, S.A., Astbury, N.M., 2024. Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: systematic review and meta-analysis. BMJ 386, e078713.
