Challenges of Generous Listening in Medical Care

Abstract

Generous listening, as Dr. Rachel Naomi Remen describes it, means listening not “to analyze…but simply to know what’s true for that other person.” It is widely recognized as crucial to promoting trust, safety, and shared decision-making in medical care. However, physicians often do not practice it the way they would like to and learn they should. This commentary argues that the reason is structural, not personal. Findings from a literature search suggest that short visit times, mounting documentation demands, and productivity-based payment models make it highly challenging for physicians to truly hear a patient's full story, and communication barriers like jargon and language discordance compound the problem further. Drawing on Walter Rodney's theory of underdevelopment, I argue that limited generous listening capacity is produced the same way underdevelopment is: by systems that prioritize efficiency and control over the people they are meant to serve. Rather than solely individual improvements, restoring generous listening will require structural fixes, including team-based care, protected visit time, and documentation support. Ambient AI scribes may also help, but they cannot fix the underlying time and reimbursement pressures alone.