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Mastering the art of listening

By Mindo - 17th Jul 2019

Mid adult woman talking to doctor about her diagnosis

Former hostage and crisis negotiator Ms Cathy MacDonald talks to Clíona Hughes about how medical professionals can improve their communication skills and the presentation she delivered at the RCPI

There are many things that run parallel between hostage and crisis negotiation and the medical world”, according to former hostage and crisis negotiator Ms Cathy MacDonald.

Ms MacDonald, who served with Police Scotland for over 30 years, delivered a keynote address at the RCPI ‘Patient Safety Through Better Communication’ conference, which took place on 19 June. Her talk aimed to provide medical professionals with additional short-cuts and tactics to help them deal with the challenging conversations they regularly face with patients and colleagues. The conference aimed to instruct on the impact that use of communication can have on the world of healthcare. “Medical professionals have a very tough job and I want to make it easier,” Ms MacDonald said. 

Ms Cathy MacDonald

A career in teaching and coaching communication skills was not something that Ms MacDonald envisaged for herself. However, after retiring from Police Scotland, she started her communication coaching business, Art of Communication.  Ms MacDonald told the Medical Independent (MI) that communication is a distinct tool that individuals need to utilise strategically. She stressed that effective communication is important within a medical environment. “I think communication is critical when the stakes are high. That is the same for a hostage negotiator and a doctor,” she argued.


Ms MacDonald explained that nobody is taught how to communicate or listen as a child; it just materialises. This can be why many struggle in how to handle certain situations or uncomfortable conversations, especially in healthcare.

“If we all understood how to communicate, to listen to each other to come to a resolution in the middle, the world would be a much nicer place. Knowing where two people are coming from and showing respect and dignity helps people to work together. The big things that I teach are what I call ‘the foundations of communication’.”

Explaining that a large part of basic communication is learning how to listen in a different way, Ms MacDonald said: “We don’t learn how to listen and like most other parts of communication, listening evolves. In school, we were told to ‘shut up and be quiet’. It’s commanding people to listen.”

Ms MacDonald stated that it is vital to pay attention to emotion in speech, in that it can help enlighten others as to what is most important to us. Ms MacDonald said that if an individual goes into a conversation knowing what they are listening for, they are more likely to hear important elements.

Ms MacDonald explained that it is difficult to improve other elements of your communication without improving your listening skills first.

“If I am talking to someone highly emotional, I need to use short, sharp and quick words, because their emotion won’t allow them to hear me. If you understand how to listen to someone, you can then find language that connects to them and the language in yourself that helps to manage challenging conversations with them.”


Often in healthcare, days vary and the unexpected becomes the expected. Conflicts and challenges tend to arise when stakes are high and pressures build. This can be stressful and cause anxiety. Certain conversations can be challenging, and it can be hard to know how to conduct them in a civil and appropriate manner, especially when speaking with patients. Ms MacDonald explains that there are certain things that can be done to alleviate tension and promote patient satisfaction through better communication.

“Challenging conversations are only challenging because you want to avoid them but can’t. Be kind to yourself as a healthcare professional; do whatever will make a situation easier for you to approach. With a challenging conversation, think about what you are going to say and plan your opening lines.” Ms MacDonald stated that the thought of the conversation is usually a lot worse than having it.

“If it is a difficult conversation with a patient, you need to just accept it. If the person is having an emotional vent and they need to get that emotion out, their ears won’t be working. They might hear words, but they certainly won’t hear your intention or what is important. They will just hear what they want to hear. You need to stay quiet and listen and accept that this is the way they feel, and they are justified in feeling that way,” she said.

“Once they have gotten all of that emotion and anger out, bear in mind that they are not annoyed at you personally. You are the representation of all of the things that have gone before. Let them vent. From a communicator’s perspective, this is a fabulous time for gaining information about what is important to them. We say far more when we are in an emotional state than we ever would any other time. It is then that we are able to grab onto exactly why they feel the way they do, and the chances are, there are some ways to make a calculated shortcut to find out what is actually troubling this person.”

What is said, and the way in which it is said, can be the difference between a positive and negative experience,
Ms MacDonald advised. “Be human. You could say: ‘If I was you, I would probably be feeling exactly the same right now, however, we are both in this situation and we are going to make the best of it. Let’s see what we can change going forward, how does that sound?’ Make the other person feel part of it. It’s a very vulnerable place to be a patient and if you’re someone who is usually in charge of things, it’s very hard to have a medical professional dictating to you.”

Emotional balance

Ms MacDonald said that most people would rather be brought along with the narrative in a conversation like this. “Show that you are listening: ‘I can hear where you’re coming from’. Make sure the person feels heard and understood. And ask, ‘where do we go from here?’ What does the person want and what do you recommend as a professional? Making the person feel included is a massive part of maintaining that emotional balance. If an emotional balance exists, communication flows better.”

Ms MacDonald acknowledged the similarities between healthcare and hostage negotiation again, noting that knowing how to negotiate effectively is an integral part of successful healthcare and staff contentment. “Medical professionals will have to negotiate often — that could be heads of departments negotiating for staff or time or equipment, it could be people negotiating for office space, it could be negotiating with patients over the type of treatment they will receive… My advice is that you have to listen to understand,” according to Ms MacDonald.

“You have to understand where everyone is coming from and what everyone wants. Understand what is achievable and what isn’t. What is negotiable and what isn’t, and why? From there, find out what the commonality is. If you think of health professionals, they have one goal, which is to make life better for everyone. They will have different ways of doing it and different responsibilities within that. If you then remind yourself of what you agree on — an efficient, cost-effective service, for example. The human part of us can do that for free. Figure out how you can work it out and what you can compromise on.”

Ms MacDonald said in a conflict situation, when what can be compromised on is established, use of language comes into play. “You need to use non-threatening, non-dictatorial language: ‘What you need to change is this’. The word ‘need’ challenges someone’s autonomy. You would be better saying, ‘how would you feel about this?’ If you have three options, you might find that you will agree on one of them. Discuss it. You can work and it will be a collaborative thing and that is where the negotiation comes in.
Negotiation goes up and down and it won’t be smooth from start to finish. Good teams learn how to have disagreements and stay friends and colleagues.

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