No. Not the kind related to a hearing impairment. I mean the type of tin ear that filters out or blocks entirely the other person's rational — or irrational — argument.

Some people with a less delicate touch than, say, yours truly, might describe someone with a tin ear as being insensitive to the point of being oblivious. Others, more prone to telegraphing messages, might shake their heads woefully and think "clueless" or, perhaps, suggest that the intellectually tin ear-impaired individual "just doesn't get it."

Of course, history's most infamous tin ear figure is poor Marie Antoinette. When told that the peasants were starving and had no bread to eat, Marie reportedly proffered the solution: "Let them eat cake." In all fairness, she was inexperienced, led a sheltered professional life and probably never actually talked to a peasant. Which, even today, is probably not as uncommon as one might think.

The tin ear phenomenon has survived — some might even say thrived — through the centuries and pops up regularly today. Even Tin Ear of the Year Awards are bestowed by various groups and individuals with subjective credentials. And tumbling out of a seemingly endless presidential campaign cycle, a number of tin ear-type declarations are on record. Of course, in politics, one man's tin ear episode is another man's moment of golden-throated clarity and truth.

Health care execs are generally pretty good listeners within the confines of our own environment. You never miss a word the chairman of the board says. And questions asked are promptly and wisely answered. Not a good idea to drop those signals. But in other spheres, we could be a tad more focused on what "they" want to say rather than on what "we" want to say.

The current classic example — and historically our most difficult — is the physician audience. We've worked very hard at knowing when to talk and when to shut up and listen. (Which, by the way, is one of life's great under-rated skills. Just ask your spouse.) So far, so good, or so it would seem, as a growing number of hospitals reach agreements that appear to be mutually satisfactory. Time will tell, as the wise man says.

Then there is the business community. Do we have a tin ear or a deaf ear? Maybe both. Even though they pay directly or pay the payers to foot a big chunk of the bill, do we hear their concerns or do we tell them only about our problems? And do we tell them about our big strategic plans without showing how those plans in concrete terms — note the phrase concrete terms — will benefit them. Either way, it's an annoying conversation. Just think back over the years about similar talks you've had with physicians. I'm sure you can relate.

So what do business leaders want to hear? They're business people. They want to know about dollars and results, cost-savings and employee productivity. And they want proof of value and transparency. The same checklist they expect from any vendor. And don't bristle about being considered a "vendor." That mindset can actually help frame the issue.

The alternative is that Big Business will continue to sign direct contracting agreements with institutions that do speak their language and experiment with — and in some cases fund — forms of direct primary care.

I don't know if it's true or not, but someone pointed out that some people with a tin ear, sometimes also end up with a tin cup. Isn't it easier to just hear what the other person wants?

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