There is a clear difference between hearing and listening. Effective listening requires energy and discipline. In his 2004 book How to be a master coach, Joseph O’Connor identifies four levels of listening:

• Hearing: This is the most superficial level, registering sound waves. You do not have to pay attention to someone to hear them
• Listening to: The pharmacist listens to the patient, but is thinking: ‘what does this mean to me?’ You are listening from inside your own experience, using the patient’s experience to trigger your memories. This everyday level of listening is adequate for everyday conversations, but not for a patient consultation
• Listening for: The pharmacist at this level is listening for something the patient says. The pharmacist may have an idea and is filtering what the patient is saying in order to make a judgement
• Conscious listening: This involves no judgement and minimal internal dialogue. The pharmacist is actively seeking to retrieve information and understand the patient. This is the optimal listening level when conducting any form of patient consultation.

Stephen Covey has a slightly different classification, and he describes several levels of listening that include ignoring, pretending to listen, selectively choosing what to listen to and paying attention to certain words. His fifth level, empathic listening, is useful. It means listening with the intent to understand. Empathic listening allows the pharmacist to understand how the patient sees their world, you understand their paradigm and how they feel.

This is how he puts it: “In empathic listening, you listen with your ears, but you also, and more importantly, listen with your eyes and with your heart. You listen for feeling, for meaning. You listen for behaviour. You use your right brain as well as your left.”