Takeaway
Listening closely builds patient trust, which is fundamental to effective care. Dismissing a patient's self-reported observations, even unintentionally, erodes this trust and can prevent you from truly understanding their concerns.
Lifelong Learning in Clinical Excellence | May 27, 2025 | 2 min read
By Mary Catherine Beach, MD, Johns Hopkins Medicine
About 18 months ago, I unexpectedly lost 10 pounds. It concerned me enough to schedule an appointment with my new primary care doctor—someone I’d only met once before. During the visit, the nurse had me sit on the exam table, still wearing my winter boots and coat while the table’s built-in scale weighed me. She announced my weight: about six pounds heavier than what I’d seen at home that morning.
When the doctor came in, I explained that I’d been tracking my weight regularly for years and was sure I’d dropped 10 pounds in a few months. He glanced at the record from my last visit and replied, “Actually, you’ve only lost four pounds.” I clarified why I thought that number was off—different clothing, different time of day, and a consistent home scale. But instead of exploring my concern, he doubled down: “You’ve lost four pounds. Same scale.”
I could tell he was getting irritated, so I let it go. But the dismissal stuck with me, making it impossible to trust any further assessments he made.
Listening builds trust
Trust isn’t built by degrees and credentials; a recent national survey found the most important thing a doctor can do to build trust is to listen, understand, and take seriously what a patient has to say. This kind of deep listening requires more than nodding along—it takes curiosity, presence, and the sincere belief that what the patient says is important. Patients are experts in their own bodies; when we dismiss their input, even unintentionally, we erode trust.
Why don’t clinicians listen?
Time pressure, electronic records, multitasking, stress, and lack of sleep all get in the way of paying close attention to what patients say. Even in calm environments, the complexity of clinical practice requires listening with multiple “ears” for clinical, emotional, and contextual details.
But maybe the biggest barrier is mindset. In healthcare, we often give more credibility to test results than lived experience. And too often, we dismiss patients’ observations as less important than our own. This is especially dangerous when our implicit biases get in the way of whose voices we take seriously, for example, analyses of medical record data have shown that African American patients and women are the most likely to be dismissed.
How to earn and keep patient trust
Here are five simple, powerful ways clinicians in every specialty can build trust through listening:
1. Pause and focus. Clear your mind before entering the room. Give your full attention.
2. Practice mindfulness. One study found that clinicians who rated themselves as more mindful spoke less and had higher patient ratings of encounters.
3. Check assumptions. Remember that we may have biases about who is believable.
4. Validate expertise. Patients know their bodies. Show them that you appreciate their knowledge and perspectives.
5. Acknowledge concerns. Reflect what you hear so patients know you are paying attention.
Listening takes deliberate intention, but its impact lasts. In medicine, trust is everything—and it starts with taking seriously what patients tell you.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.