Medicine is a life of learning. Take My Advice is a Medscape series where physicians share their best lessons, the wins and losses, and how to use everything you know to become a better caregiver every day.

The first time I volunteered at the Navajo Reservation in Chinle, Arizona, the learning curve was steep. I was 8 years into my career as an emergency room (ER) doctor. I was used to the cadence of the ER with its constant pressure to move from patient to patient. I had my style, and it had always worked.

Not anymore. I would ask the patient a question. Often there was an interpreter who would translate. The two of them would go back and forth with pauses in between several questions and answers before the translator translated the response for me. There were many periods of silence. This took a long time. All the while, I was churning inside with frustration at the slow pace.

One of my patients was a 7-year-old who’d fractured his femur. I explained the diagnosis and the need for transfer to his parents. It was clear that they were uncomfortable, and I could sense that I was doing something wrong. Eventually, it dawned on me that the parents expected me to speak with their child directly. Even though he was only seven, they were confused as to why I hadn’t taken the time to explain everything to him in detail as well. After all, he was the patient.

Determined to improve my communication, I asked the medical director on the Reservation, a former colleague, for advice. He explained that in Navajo culture, conversations require patience and active listening. People talk, then indicate with a gesture or look when they’ve finished speaking. There are pauses, sometimes several seconds or even a minute long. “Things are done differently here,” he said. “Just go with it.” 

He was right. I couldn’t make the process faster. I was in their environment, not mine. This wasn’t the ER, with its assembly line of patients who needed to be moved along. I had to slow down. As I worked on my listening skills, I realized I felt more engaged with patients than ever before.

Some time later, a woman in her late thirties came to see me. She said she had a minor bruise and anxiety. In the past, I would have asked her a bunch of questions and discharged her. Instead, I was quiet and listened. Eventually, she revealed that her home life was stressful due to her husband’s drinking. I was able to get a counselor in to see her. 

In our culture, we’re quick to interrupt. When someone is talking, we are already thinking about what we’re going to say next instead of fully listening. People who don’t speak quickly are often not heard. This applies in medicine, and especially in the ER, where all encounters are new and unexpected.

As clinicians, we have a lot of boxes to check. We go down a list of items that must be completed, too often with a rapid-fire style where the patient never gets to express their primary concern. 

I changed my approach — both on the Reservation and back home in the ER. Unless it was a raging emergency that required immediate attention, I would begin by making sure I was physically present. I usually brought a rolling stool into the room so I could sit down at eye level with the patient. I’ve seen too many doctors hanging in the doorway looking at their screens or clipboards, which sends the message they aren’t fully engaged.

I’d introduce myself by name and ask the patient and those present to tell me their full names and relationship to the patient. Then I’d ask the patient why they were there and how I could help.

Next — and this was the most important part — I’d look at the clock and force myself to be silent for 2-3 minutes. At first, it was hard. But what happened was this: Patients started providing me with better information. I got a better sense of their symptoms and concerns. It turned out to be more efficient than asking questions one after another.

When you let patients and their families talk, they often reveal information that leads to a better differential diagnosis. By taking a few minutes of silent, uninterrupted listening at the beginning, I was saving time at the end.

Consider a patient with abdominal pain where there are so many possible causes, from minor to life-threatening. If you ask rapid-fire questions, you might never learn about a key symptom. The same thing is true with neurologic symptoms, such as dizziness and headache.

I never stopped working to connect with my patients. When appropriate, I played a game with myself where I aimed to find common ground with them. You can almost always find something to connect around: kids, grandkids, travel, school, sports, or hobbies. If they said they were an artist, I’d tell them my wife was on the state’s art council. If they were a carpenter, I’d share that my grandfather had worked at a furniture factory. You look for clues from the person. It worked 80%-90% of the time.

In more than 45 years of practice in a field where lawsuits are common, I was never sued personally, and it was not because I never made a mistake. After all, no one practices 100% error-free medicine. I believe it was in large part because my patients felt heard. Even when things didn’t work out well with their health, they could tell I was engaged with them and their care.

I ended up volunteering at the Navajo Reservation three times for a total of 6 weeks. I learned how to listen. It turns out it was not difficult, and it didn’t take much effort. But it did make me a better doctor.

Dan Morhaim, MD, is an emergency medicine and internal medicine physician in Baltimore. He currently serves as a medical director for ambulance companies, a clinical consultant for health IT companies, and a faculty member at George Washington University. He is also a volunteer physician with Remote Area Medical. Morhaim has authored two books, including Preparing for a Better End.

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The experts cited in this article had no relevant disclosures.