Listen Dr Kathryn Mannix

As a trainee geriatrician, I am always on the look-out for books about death and dying, as these themes form a consistent theme within older adult healthcare. I had read Kathryn Mannix’ first book ‘With the end in mind’ several years ago, and had enjoyed the way she opened up the conversations around life, death and the space between, in a quietly encouraging way that appealed to me both as a doctor, but also as a daughter and friend. I picked up a few new tips and tricks from this first book, and so when ‘Listen’, Mannix’ second book about opening up tender conversations, was released in September, I was quick to read it too.

‘Listen’ is not really for healthcare workers at all, aside from being for us, because we are all also people with families and friends who at times need us to sit and listen closely, and because we are all people who at times, need to be fully listened to. It incorporates a range of stories to illustrate some of the barriers we can face to listening well. Some of these were familiar to me from my clinical practice, such as the family struggling to support someone with cognitive decline, which seems to everyone like an elephant in the room, or the teenager struggling to juggle a significant health condition that feels incredibly unfair. Some stories had nothing to do with medicine, centring on kind teachers, conversations round dinner tables, and a challenging telesales encounter. All of them were focussed on the reminder that when we listen, we are participating in a conversation, and that sometimes, it is the other person who is most important, and who needs to be given the space and time to lead. All of the included storied had real heart, and alongside the big issues covered, there were beautiful moments of affirmation, joy, and real tenderness. Mannix compares communication to a dance – it needs two people, who are engaged and wanting to work together, and I felt this was a helpful metaphor to keep in mind.

Often in clinical practice, and particularly when we are working under pressure, significant and tender conversations jostle with other tasks on our lengthy job lists. Chase Mr Jones’ MRI scan. Speak to gastroenterology about Mrs Singh. Get a collateral history about Mrs Lee, to see if she can return home. Phone Miss Macdonalds niece, and say she is likely to die soon. These are not really equivalent tasks, are they? Our intentions are often driven by a need to either impart specific information, or collect it, ideally as quickly as possible, so that the next task on the list can be tackled. My main learning point from Listen, was to remind me to make the mental shift to thinking about conversations, rather than tasks and to remember that although we like to organise our day into a series of little boxes to be shaded in, that tender conversations rarely work this way. Communicating well is not just about the quiet rooms and the peaceful décor (those these all help). It’s also about learning  to shut up, and giving a bit of control back to the person who matters most, something I suspect many of us struggle with, a little. It takes two to tango, after all.

Listen, is a quiet sort of book, that stays with you after you have closed the covers. I found myself thinking of it in the weeks after finishing it, thinking back to some of the vignettes featured, and wondering how me and my communication skills would appear, if one of my own patients’ stories had been described. This in itself has been an interesting exercise and made me reflect on encounters in a new way. I suspect this will also be the case for any of you, readers, who seek out this book.

Enough reading now, the challenge is… to start listening.

Dr Charlotte Squires

Dr Charlotte Squires is a specialist trainee in Geriatric Medicine in Edinburgh, and a member of the RCPE Trainee and Members Committee. She tweets at @charsquires