Barriers to Listening and How to Overcome Them

Even experienced professionals face barriers that diminish listening. Obstacles can come from the clinic environment, practitioner assumptions, or competing demands on attention.^[1][2][6]

Recognising and managing these barriers ensures patient concerns are fully understood and addressed.^[8][5]

Time pressure in busy practice

Short appointments, unexpected findings, or administrative tasks can compress discussions. To mitigate:^[3]

• Structure the consultation so the main concern is addressed first.^[5]
• Use signposting (e.g., "Let's start with what's worrying you most...").^[5]
• Build pauses into testing to let additional concerns surface.^[4][3]

Assumptions and cognitive bias

Assumptions based on age, symptoms, or prior diagnoses can filter what is heard.

^[2][1]

Reduce bias by opening with broad questions, reflecting back key points rather than inferring meaning, and considering differentials systematically before narrowing conclusions.^[2][5]

Environmental and digital distractions

Multitasking - recording notes, checking pathways, managing equipment - can signal inattention. Minimise distraction by:^[6][7]

• Positioning screens to keep the patient visible while documenting.^[6]
• Explaining actions ("I'm just recording this finding while you talk.").^[7]
• Creating a distraction - free opening before using digital systems.^[6][7]

Emotional and interpersonal challenges also matter. Acknowledge anxiety, keep a calm tone, and use reassurance without dismissing concerns. Communication - skills training supports attentiveness in difficult interactions.^[8][5]

References (numbered in text) Why we include references

1. Standards for optical students — General Optical Council Find (opens in a new tab)
2. Gustavo Saposnik, Donald Redelmeier, Christian C Ruff, Philippe N Tobler et al., Cognitive biases associated with medical decisions: a systematic review. BMC Medical Informatics and Decision Making (2016) Find (opens in a new tab)
3. Natasha Elmore, Jenni Burt, Gary Abel, Frances A Maratos, Jane Montague, John Campbell, Martin Roland. Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care. British Journal of General Practice (2016) Find (opens in a new tab)
4. Wolf Langewitz, Martin Denz, Anne Keller, Alexander Kiss, Sigmund Rüttimann, Brigitta Wössmer. Spontaneous talking time at start of consultation in outpatient clinic: cohort study. BMJ (2002) Find (opens in a new tab)
5. Jenni Burt, Gary Abel, Natasha Elmore, John Campbell, Martin Roland, John Benson, Jonathan Silverman. Assessing communication quality of consultations in primary care: initial reliability of the Global Consultation Rating Scale, based on the Calgary-Cambridge Guide to the Medical Interview. BMJ Open (2014) Find (opens in a new tab)
6. Richard L. Street Jr, Lin Liu, Neil J. Farber, Yunan Chen, Alan Calvitti, Danielle Zuest, Mark T. Gabuzda, Kristin Bell, Barbara Gray, Steven Rick, Shazia Ashfaq, Zia Agha. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. Patient Education and Counseling (2014) Find (opens in a new tab)
7. Neda Ratanawongsa, George Y. Matta, Fuad B. Bohsali, Margaret S. Chisolm. Reducing Misses and Near Misses Related to Multitasking on the Electronic Health Record: Observational Study and Qualitative Analysis. JMIR Human Factors (2018) Find (opens in a new tab)
8. Vinicius C. Oliveira, Manuela L. Ferreira, Rafael Z. Pinto, Ruben F. Filho, Kathryn Refshauge, Paulo H. Ferreira. Effectiveness of Training Clinicians' Communication Skills on Patients' Clinical Outcomes: A Systematic Review. Journal of Manipulative and Physiological Therapeutics (2015) Find (opens in a new tab)