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The Exchange begins with effective listening. Most of us assume that listening is an instinct; it is something that we know how to do without trying. It's also pretty clear that almost from birth we also want other people to listen to us. Babies cry to alert a parent that something is needed—a dry diaper or a mouthful of milk. And yet, it is also clear that some listening is not very effective. If you have or are familiar with children, you have probably witnessed a scene involving a toddler tugging on a parent's leg or arm or anything "tuggable" and demanding attention. "Listen to me" is the unspoken plea.

If listening is not an instinct, at least it is something we learn very early. Remember your parent demanding, "Listen to me, young lady"? And yet, in our experience, most conflicts begin because someone feels that he or she has been ignored, misinterpreted, or treated disrespectfully by someone else who didn't really listen to him or her. We've also observed that in many situations, the "other" party actually was listening but not effectively listening.

Multitasking may be an important skill in this complex multi-demanding world of health care but to be effective in managing conflict, one must at least give the appearance of providing full, undivided attention. In the beginning, you may just have to act like you are paying attention. Be assured, emotions often follow behaviors and soon you will be fully present for the other person. And you will have developed a skill that will earn you great rewards. A skill that can be practiced and improved so that you actually are paying attention!

Most human beings want to understand other people and be understood by other people. We want the messages we send to be received in the spirit in which they were intended. We also want to know that the real message, the meta-message of the feelings behind the words, was received. Overall, we want to know that someone has really listened to us. One doctor told us that he didn't understand his staff. When the staff complained about things, he would quickly analyze the problem and give them his best solution, sometimes what they said they wanted. He was puzzled that they often left his office unhappy until one staff member said that she wasn't looking for his quick and abrupt answer, she wanted him to actually hear her out and acknowledge her experience, not just fix it for her. The way in which he listened felt dismissive, and his answers were hasty, so she was never sure he understood the true issues.

So what is effective listening? We define it as when the speaker believes that he or she has been heard because the listener demonstrates certain behaviors. It's not as easy as it sounds. ...

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