This episode is for you if you’ve ever felt that particular kind of embarrassment that comes from realizing you missed something everyone else caught. Because this episode is about noticing our noticings.
Hi, everybody. This is 10 Minutes to Better Patient Communication from Health Communication Partners. Since 2017, we’ve been giving you inspiration and strategies to improve engagement, experience, and satisfaction. I’m Dr. Anne Marie Liebel, a researcher, consultant, and educator specializing in communication and education. This podcast makes space to dig into what it’s easy to take for granted about communication and our professional lives, especially in healthcare and public health, but increasingly across sectors because communication touches everything. We’re here to learn and get inspired, but most importantly, make the difference we got into our jobs to make. I help organizations act with clarity and confidence in complex, high-stakes situations. I’m currently booking consulting clients. You can work with me. Reach me on LinkedIn, on Instagram at healthcommunicationpartners, or at healthcommunicationpartners.com.
Now, today’s episode grew out of a conversation I had with a physician. He was telling me about how he feels pretty good about his ability to notice when he’s explaining something to a patient and it’s not going well. Maybe the patient stops following him. He says he’s pretty good at noticing if there’s that, you know, a shift, a pause, or a look that tells him he’s lost ’em. He notices this in time and he can make the decision in the moment to pivot. Try a different tactic. Listen more, ask questions, make some changes. That is not what he was worried about.
His worry was what else he was noticing. He was in a teaching hospital and the other clinicians in the room, the clinicians he was educating, he noticed were not picking up on some of the same patient cues that he was. So his picking up on cues, pivoting in the moment, changing what he was doing, responding to the patient…that didn’t magically transfer to the people he was teaching.
Now let’s talk about these cues that he was noticing. Because objectively speaking, the cues he saw would have been available to anyone in the room. But I thought it would be good to just, let’s list a couple of these cues that we all notice, but are so subtle, we don’t usually get the time to talk about them.
- So we could think about like outright verbal cues. That’s when people say something using words, but not a straight out sentence. We’re talking a little more subtle than that. Hints. Maybe words that have an emotional charge to them. Whispers. Muttering.
- Then there’s even more subtle indications we can all give when something is off: sighs, those tsks, ticks, hums, sounds, those vocalizations that aren’t words.
- Then there’s nonverbal, non-vocal. We’re talking about facial expression changes, wincing, frowning, looking away, looking down, knotting your brow, avoiding someone’s gaze, briefly holding your breath, long pauses.
We all know about all of these, and I’m sure you could name more of them. But catching these in the moment isn’t automatic. It’s especially difficult when your attention is elsewhere, and the clinical encounter is such a complex and information-dense environment. What’s worse is that we don’t usually know that we’ve missed something because nothing signals that there was a cue that went by and you didn’t catch it.
Now, physicians missing signals from patients worried my physician friend on several levels, because he knew what missed cues could mean downstream. Patients might leave the encounter with questions that are unanswered. They might agree to things that they didn’t fully grasp, or they might leave important information unsaid.
He also didn’t want the other clinicians to miss that information, or be working under an inaccurate read of the patient’s condition, or an inaccurate read of the patient’s preferences or values. He didn’t want them leaving the room believing things went fine, simply because they missed the sign that maybe things weren’t fine. These were real concerns about his practice as a physician, and also as an educator.
Underneath his concern, there seemed to me to be another question. How did he know how to catch these cues? Why was he good at this? And the more I thought about that question, the more I could see why he was stressed, because there were a couple possible answers, but none of them sounded really positive.
On one hand, maybe he always was good at this. He always knew how to read the room like this. Well, that would indicate it was innate, something some people simply have a feel for and others don’t, which would make it essentially unteachable.
On the other hand, maybe he did learn it over time. That would indicate it’s teachable, but only through a kind of slow, repeated exposure that took him years, which could make it teachable in principle, but really complex in practice.
Well, I have, I think, another way to think about this. A client once told me that she appreciated what I did for their team was help them “notice their noticings.” And that’s why I’m bringing up this physician’s dilemma. You are incredibly skilled assessors. You are not not paying attention. You are professional noticers.
So if you’re concerned that you or people you’re teaching aren’t noticing what’s important, take heart. Because we can all get better at noticing, with the first step of noticing what we’re already noticing.
So what does it look like to help someone notice their noticings? What does this look like in practice? I’m going to give you a few concrete possibilities.
Now this physician was talking about actual patient. interactions where other clinicians were present in the room. If this is you, some options to consider here. Review those real encounters together as soon after the moment and ask people, what did they notice? The idea being you want to hear, did multiple people notice the same thing? So it’s cool if you notice the same thing, tell people that. If you noticed something different, say that too.
And here you want to name the specific cues that you noticed explicitly rather than assume that they’re obvious once they’ve been pointed out.
But what if you’re watching training? Well, if that’s you, you get to name a cue out loud in the moment. Shout it out as it happens
rather than after the fact. Get your peers in on this if you can, because again, multiple perspectives here helps us all see things that we’ve been missing.
These are a couple ways of making an invisible skill visible. Don’t forget to build that habit of checking in on what a patient actually understands by asking them and getting them to say it in their own words.
This physician was worried about outcomes, downstream effects of not noticing something important but subtle. What I really want to emphasize here is this isn’t about a lack of attention, or a weak innate ability, or a lack of care. It’s that noticing your own noticing is difficult, especially in complex situations. It’s got to be pointed out, made explicit, and made intentional before it can be built on or taught to anybody else.
I’m going to invite you to send in a scenario or a challenge that you’d like me to break down in a future episode. Visit healthcommunicationpartners.com and click on contact. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music from Joe Liebel. Additional music from Alexis Rounds. Thanks for listening to 10 Minutes to Better Patient Communication from Health Communication Partners, LLC. Find us at healthcommunicationpartners.com.
