Listening to sounds in the clinic that PCPs ‘take for granted’ can improve care

Key takeaways:

• Sounds in the clinical environment can be a tool for PCPs to learn more about their patients and offer better care.
• For example, providers noticing quickened speech and nervous tapping could consider anxiety.

The sounds of a primary care clinic often become white noise to the modern overworked provider, but paying attention to these everyday noises can play an important role in quality care, according to an expert.

Martina Ann Kelly, MBBChBAO, MA, PhD, FRCGP, CCFP, a professor of family medicine and community health sciences at University of Calgary’s Cumming School of Medicine, and Gerard Gormley, MBBChBAO, MD, a clinical professor at Queen’s University Belfast in Northern Ireland, authored a reflection in a recent edition of Annals of Family Medicine.

In the narrative essay, they evaluated “the soundtrack of the daily grind” primary care providers experience every day.

“Often taken for granted, we suggest the sounds of practice form an important role in our daily lives as family doctors,” they wrote. “Masked in these sounds are tacit skills and auditory expertise that speak louder than words.”

Healio spoke with Kelly to learn more about the “hum and drum to the clinical day” and what PCPs can learn from the noises around them.

Healio: Why did you choose the sounds of a clinic as the subject for your reflection?

Kelly: As a researcher, I am particularly interested in the role of the senses in clinical practice. I conducted my PhD on how physicians use (and learn) touch in clinical practice. While doing this research, I realized how difficult it is to study a sense in isolation — they are always mixed up; eg, touch and sight, sight and sound. So, I started thinking about sound.

This was also, in part, because one day I was listening to a child cry in another consultation room. The child was clearly distressed, but I didn’t rush out; I just continued seeing my patient. If I’d heard that child outside my clinic, I would have been running! This made me question: how, as doctors, do we learn which sounds to attend to and which to ignore? Is it possible that we learn to ignore certain sounds — patients crying out, phones ringing? So many sounds are part of my background noise. If anything, it’s the silence or quiet that makes my heart race more; then I’m ‘full on,’ knowing it usually signals something serious. How do I hear silence in a noisy environment?!

Healio: You also use silence and sound to describe the vulnerability of patients. How can PCPs use everyday sounds that they might take for granted to better evaluate patients? (Are there sounds they could look for to recognize an anxious patient? etc.)

Kelly: Part of my interest in researching the senses in clinical practice is my observation that efficiency is superseding being with patients. We enter a room, and our attention is often directed at the computer, entering information, over really engaging with our patients. Patients notice that. They want our attention — rightly so. Trust requires eye contact, proper listening. Often, much vulnerability is not conveyed in words; it is communicated nonverbally. This requires us to listen — and hear — pauses, intakes of breath, sighs of happy memories and sounds of fear.

Anxiety may be the sounds of nervous tapping, a quicker tone of speech, clenching and unclenching of teeth, or tearing a tissue. It can be hesitancy — the slightest pause before an answer. We can hear it in a pulse rate, breathing rate. As a family physician for over 25 years, I hear these sounds, especially with patients I know. But as a teaching physician, I am often struck that my residents don’t. They are focused on gathering information and solving problems.

Listening is important, and we do teach that in medical school. But listening to what? Just the words, or should we go a bit deeper? Sometimes it’s listening to my own pulse rate in response to whatever is happening in the room. What do I pick up on and how do I respond?

One further thought in relation to silence and inequity is the importance of attending to it, especially for equity-seeking groups. Medicine is powerful. Patients can be vulnerable. Those who speak up often have more than perhaps people who are positioned as less deserving because of structural inequity. Hearing anger or fear, and encouraging people to speak up is super important and often entangled with ‘reading’ the patient’s body, eye gaze, posture, etc.

What I’m trying to explore is how sound becomes part of the embodied expertise of a physician, yet often something I don’t articulate. In this essay, I tried to really listen to my own body to try to put that experience and expertise into words. It’s hard to translate! Maybe if I were a musician, I could annotate the cadence, tone and volume of the sounds.

Healio: Is there a way for PCPs to use sound as a way to relax, perhaps to even reduce burnout after the long day you describe?

Kelly: Interesting! I had not thought of it like that! Personally, I need quiet after a busy day. I love sitting on the sofa, listening to our wood fire, just quiet. That way, all the sounds of the day flow through me and I can let them go.

I am struck, too, by how noisy contemporary society is. My students love to study in coffee shops, with ear buds, so I wonder if there may be a generational aspect to how we listen and hear sounds?

Healio: What is the take-home message for PCPs?

Kelly: I guess in writing this article, I just wanted to help other docs attend to all the sounds we take for granted. Being mindful of how sounds permeate and percolate through our day; that responding to certain sounds becomes an automatic expertise yet often is foreign to our patients and learners. How can we make people more comfortable in our clinical soundscapes? How do we recognize the cognitive load it places on patients, new learners, new staff?

For more information:

Martina Ann Kelly, MB, BCh, BAO, MA, PhD, FRCGP, CCFP, can be reached at makelly@ucalgary.ca.

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