I recently listened to Iona Heath’s lecture. It’s hard not to agree with what she says, focusing on my experiences, emotions, relationship between me and my doctor. But then, when we talk about conversations, are we really talking only about language? And so, I want to write about something I’ve been thinking about for some time (but done not much more than thinking), the voice.
When I was listening to the best interviews I ever conducted (I wrote about them here), I noticed something quite surprising, something I had not been aware of during the conversations. My voice changed all the time. Sometimes it was loud, quiet, sometimes I also whispered. Sometimes my voice was cold and, shall I say, professional, matter-of-fact, but sometimes sometimes soft, caring. Also, it turned out that my voice was responding to the voices of the men I was interviewing. When they were lowering their voice, I was lowering mine, completely unaware I was mimicking the way they spoke.
And here is my problem. As I listen or read about medical communication there is plenty on how to ask questions (yes, among others the open-question nonsense), about the language you use (Iona Heath speaks, for example, about language which can be understood by every patient) and never about how it is realised, the voice in which it is delivered. In fact, when I did a quick search on voice quality in clinical communication (admittedly, I didn’t put much effort into it), I found nothing. And, intuitively, it seems so important.
One of the exercises I have often been asked to do with future psychologists or psychiatrists is mock interviews. We discuss linguistic/discursive workings of what the prospective clinicians say. The students are often astonished when we deconstruct what was said. And then, I was once ‘interviewed’ by a student whose voice was just mesmerising. Some of his questions were quite terrible – pathologising, patronising, biased. But both I and other students agreed the interview was the best of the lot and it was because of his voice. It was calm, warm, inducing trust. As I said – mesmerising (it turned out later that the student was about to finish his training in psychodynamic therapy, which explained at least some of it).
Accident? Of course, it’s not. There is significant research on perception of voice, or voice attractiveness and its impact on people’s perceptions of the attractiveness of the person (admittedly, focusing mostly on sexual/interpersonal attractiveness). There is also politics. As we are remined that Margaret Thatcher’s stopped being ‘the shrill housewife”, more recently, voice was an issue in the US presidential campaign with Hillary Clinton being accused of being ‘shrill’ (yes, of course, it’s sexist – here is Debbie Cameron’s great post on it). Voice is certainly not transparent. And yet, despite so much focus on empathy, relationship etc., medicine seems to be quite uninterested in how clinicians say things. As long as you ask an open question….(sigh).
I have had the misfortune of seeing a number of doctors over the last weeks – I have been ill (yes, still the same thing and there are a number of blogposts coming out of this soon). Yes, I am an awkward patient. I am also an academic in such encounters and I cannot help observing what’s going on. Once an ethnographer, always an ethnographer.
Here I want to write about one consultation, as it was all about the doctor’s voice. The doctor was matter-of-fact, politely curt, mostly uninterested (empathy didn’t really get into this), but the voice…. Gosh, it was so irritating. It was almost unchanging, same pitch, same loudness, same, shall I say, coldness in it. It was almost like talking to an android (Lt.Cmdr Data was an epitome of empathy in contrast!) with a pre-programmed voice quality and the android forgot to switch on modulation. Apart from one moment. When I started asking questions about the treatment the doctor was proposing, the voice changed. It was irritated, curt, dismissive. My doubts were answered , but in a way which suggested they were unwelcome, taking liberties. It was the voice that told me I overstayed my welcome. I hated it, but I didn’t really feel like picking a fight. I felt so unwell that I let it go.
Time to conclude briefly. Note how many different ways I described doctors’ voices. Dismissive, irritated, soft, trust inspiring. Cold, caring, professional. Curt, matter-of –fact, mesmerising. Gosh, what a vehicle for empathy (or its absence), isn’t it? As you modulate your voice, you can make me feel comfortable, welcome, a partner in conversation. On other other hand, however, the voice seems also to be responsible for setting up a relationship of power (a much trodden theme in doctor-patient exchanges). Yes, it is through your voice that you can also show me my place
And yet, it seems, you tend not to pay much attention to your voice. And so, let me finish with a plea: Medic, voice thyself!