Good listening is a... um-hmm... good excuse

Joe likes to take his time; if people were cars, Joe would be a tractor, the old muddy type with straw sticking out everywhere, travelling unhurriedly along the main road at 20mph, while a big queue of frustrated motorists builds up behind.

'I really miss her,' he said. 'She was a great oul' cow.' An unusual grief reaction, I reflected, some human-animal relationships are too close for comfort, but hey, love's a funny thing; as Shakespeare observed: 'Love looks not with the eyes, but with the mind/And therefore is wing'd Cupid painted blind.'

And it's not our place to be judgmental; if Attila the Hun, Adolf Hitler or even Harry Potter (OK, that's stretching my good nature) came into the surgery, we'd have to ignore their infamy and treat them to the best of our ability, prescribe unnecessary antibiotics, send them for unnecessary X-rays, give them unnecessary sick certs, etc etc.

A bit of counselling was indicated, so I patted him on the knee and said: 'There, there.' I also put a fake look of sympathy on my face; I've practised it in the mirror, and it looks much more impressively sympathetic than my real look of sympathy, which I am told looks like I've just smelt something unpleasant. But faking emotion is a long and honourable medical tradition; artifice is one of the ultimate expressions of human genius.

Joe continued to drone on and on about his grievous loss at a metaphorical 20mph, and I pretended to listen intently. Counselling websites will offer a lot of pseudo-scientific guff about listening. There are even sub-species, such as active listening, passive listening, reflective listening, etc.

Active listening includes, and here I quote directly: 'Responding appropriately, by um-hmming and eyebrow raising... ' However, the wise GP can dredge a few pearls out of this morass of nonsense.

For GPs, listening has one purpose; it is a period of calm during which we work out what we are going to say next, with the overall strategic goal of getting the consultation over as speedily as possible.

Joe's lamentations had finished; the tractor was idling (metaphorically) but still ready to roar back into life if receiving the right sort of encouragement.

'So what do you think, doctor?' he asked.

'Um-hmm,' I said.

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