title: The listening loop: a model of choice about cues within primary care consultations.
abstract: BACKGROUND
  As well as hearing a story at the start of an interaction, listening in medicine involves picking up and checking out patients' cues. Despite this, cues are frequently missed or ignored by doctors.
  
  
  OBJECTIVE
  To explore the perceptions of general practitioners (GPs) about initiating listening and choosing not to listen during interactions.
  
  
  METHODS
  Qualitative study constant comparison. Methods General practitioners with over 5 years' experience in practice in a semi-rural area of England took part in a single, semistructured, audiotaped interview which was piloted initially. Interviews were transcribed and analysed according to the precepts of constant comparison.
  
  
  RESULTS
  In total, 23 of 24 eligible doctors participated. The data emphasise the importance of spotting cues during interactions. Factors influencing judgements on whether or not to attend to cues included pressure of work, the doctor's mood or feelings about the patient, and the context of the interaction. Methods of limiting, blocking or resisting listening included reassuring, changing the subject, interrupting, being directive or making a plan, reducing sympathy and using body language. A tramline metaphor of choice in listening emerged (the listening loop: a definite period of listening by the GP within the interaction, generally separate to hearing the patient's initial story).
  
  
  CONCLUSIONS
  The listening loop offers a simple model of listening that emphasises choice and judgement in response to patients' cues within interactions. Emphasising this choice highlights both picking up cues and pragmatic limits and resistance to attending to them, with implications for teaching.
authors.affiliation: Division of Primary Care, University of Manchester, Manchester, UK. cocksedge@doctors.org.uk
authors.forename: Simon
authors.initials: S
authors.lastname: Cocksedge
authors.forename: Carl
authors.initials: C
authors.lastname: May
mesh_terms: D001291:Attitude of Health Personnel; D002755:Choice Behavior; D003142:Communication; D003463:Cues; D004739:England; D005194:Family Practice; D006801:Humans; D007600:Judgment; D010465:Perception; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D012423:Rural Health