Listen Up!

Where You Listen Is as Important as How You Listen

More and more companies are inviting customers to their headquarters in an effort to "get close to their customers" -- by getting those customers to express opinions on current and future products. There's nothing wrong with bringing your customers to you. But if you want to hear the most powerful insights, it's much more effective to go to your customers.

Listening to customers in their own environment is more honest and spontaneous than trying to get them to respond in a controlled setting. "Customers have been researched out," says Steve McCallion, 36, director of research and design planning at Ziba Design, which creates products for such clients as FedEx and Intel. "It's medieval to make your customers come to you," adds Martha Rogers, 48, coauthor of "The One to One Future: Building Relationships One Customer at a Time" (Bantam Doubleday Dell, 1993).

Michael Rich, 46, is a Harvard-educated physician who specializes in adolescent medicine at Children's Hospital in Boston. Medicine is a field that's famous (if not infamous) for its medieval approach to interacting with customers. But Rich is a maverick. He doesn't wear a white coat. He doesn't shoo patients out the door after just 15 minutes. And he doesn't assume that just because he's the doctor, he has all the answers.

"Medicine is not a religion; it's a service industry," argues Rich, talking a mile a minute about how to improve doctor-patient relationships. "Yet as doctors, we often block ourselves from getting information that we most need to serve our patients. We need to listen to patients within their framework. They're the experts; they live with their illness every day. We can learn from them."

Rich learns by listening -- and by looking. The sterile confines of an examination room, he says, don't encourage kids to explain all of their symptoms, or to come clean about whether or not they're taking their medicine. That's why (for example) Rich gives his asthma patients video cameras to document their illness and to teach him about their lives. The camera lets children talk on their terms -- when they feel comfortable. He urges patients as young as 6 (and as old as 25) to use their camcorders in their bedrooms, at playgrounds, or on soccer fields for 8 weeks. His patients also interview friends and family.

The contrast between what patients tell him and what they say on tape is remarkable, Rich says. Videos reveal asthma-inducing allergens that his patients had never mentioned: In one tape the mother of one of his patients is smoking in the house, despite her assurances that she only smokes outside. Others show a living room full of plants, and a kitten in the bed of a patient who's allergic to cats.

Tapes also let Rich know whether patients are taking their medications correctly. Recently, he studied 21 videotaped narratives of severely asthmatic patients. He concluded that 16 of them were making serious mistakes with their medicine. Some were taking far too much, while others had discontinued their medicine altogether.

Even more important, Rich sees complex human dynamics that might never surface in his office but that have a huge impact on treatment. In one taped segment, for example, an 11-year-old girl and her mother began arguing after her mother accused her daughter of using her asthma to get attention from other family members. "Everyone treats you like some kind of queen," the mother says, raising her voice. To which the girl angrily retorts: "Do I sense jealousy? Shut up!" Little wonder, says Rich, that the girl has problems taking her meds consistently.

But these videos do more than just highlight his patients' problems; sometimes they actually change lives -- which is just what they did for Melinda Emmanuel, an 18-year-old single mother who was finishing her senior year of high school when she and Rich first encountered each other, about 5 years ago. Back then, Emmanuel had a reputation for being so argumentative, so combative, that few doctors wanted to treat her. That first meeting with Rich was dire: She had run all the way from her train stop to Children's Hospital, an activity so taxing that by the time she reached the hospital's adolescent clinic, she collapsed on the floor, blue from lack of oxygen.

Once Rich began treating her regularly, he gave Emmanuel a video camera, which, she says, was "one of the best things that's happened" to her. "Dr. Rich gave me the camera and said, 'Show me your world. Use the camera to show me when you have attacks -- even take it to school,' " she recalls. One video revealed that within eight minutes, she used her inhaler twice, which was essentially an overdose that caused her to begin coughing uncontrollably. When Rich saw that, he worked with Emmanuel to even out her dosage.

In another taped segment, Emmanuel confessed to Rich and an allergist that she had stopped taking her steroids, because she was fed up with their awful side effects. The allergist warned that she could die without that medication. To which a scowling, slumping Emmanuel shouted, "I don't care!" Of course, she did care: "When you're young, you're not supposed to be this sick. I had difficulty making my point without getting angry." But what did help Emmanuel deal with her anger was realizing, after watching her tapes, how angry she actually was and how that anger prevented her from getting adequate medical care.

Today, Emmanuel, now 22, is only a year away from a degree in nursing and midwifery. According to Emmanuel, Rich's method of tuning in to his patients saved her life.