Don’t "Should" on a Community: A Lesson in Listening

Hi,

I’m Dr. David Higgins—a pediatrician, public health physician, and researcher focused on turning scientific evidence into real-world community health impact. In this newsletter, I share practical insights, thoughtful analysis, and frontline stories that shed light on complex public health challenges and explore how we can build healthier, more resilient communities together. If you haven’t already, subscribe below for free to stay connected.

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This is part 2 of a 3-part series on what I have learned, and continue to learn, from real conversations about how we communicate science in our communities.

Photo by Brett Jordan on Unsplash

“Your priorities aren’t our priorities.”

This statement stung.

It wasn’t just an observation. The underlying message was clear: their priorities are different than mine, and I wasn’t taking the time to listen. I made the mistake of assuming I already knew what the community needed and wanted.

This comment came from a community member while I was planning a vaccine-related project in a rural area. I could have interpreted it as vaccine hesitancy or anti-vaccine sentiment. But as the conversation continued, I quickly realized that was not the case at all. The truth was much more straightforward: vaccines weren’t near the top of their priority list.

How often do we come to a community armed with data, degrees, and our experience and tell them what they should care about? We may not say it outright, but the message is clear: “Here is what matters. Here is what you should prioritize.”

To be fair, it’s not always arrogance. It is true that we often bring health or scientific expertise that may not be available locally. And we may have reviewed the evidence, identified risks, and designed interventions. But if we don’t stop to understand what the community cares about and why, we risk wasting our efforts and damaging trust.

This same dynamic plays out in clinical care all the time.

Photo by fr0ggy5 on Unsplash

When I walk into a patient’s room, I bring a list of priorities to address: high blood pressure, obesity, and missed vaccinations. This list isn’t random. It is based on my training, the best available evidence, and chart review. But if I focus only on my list and ignore the patient’s concerns, we both lose.

Patients and families bring their priorities too. If their priority is a mole they noticed, and they can’t stop worrying about it because they lost a friend to cancer last year, they won’t hear a word I say about my priorities. Their concerns will go unaddressed, mine will too, and both are important.

In a 2020 study, Abraham Verghese and colleagues described strategies that enhance clinician presence and connection. Among them were listening completely, setting priorities collaboratively, and connecting with a person’s story. Yet, research shows that, on average, physicians interrupt patients only 11 seconds after asking about their concerns. We have to do better. It’s also not enough to just let patients speak; we must truly listen and partner with them to ensure everyone’s priorities are acknowledged and addressed.

I can already hear the response: “But time is so limited and appointments are too short.” I get it. I feel the same time pressures, and our health systems must change. However, the flawed assumption here is that listening and engaging will take significantly more time.

Surprisingly, as Verghese and colleagues noted, studies show that using effective communication strategies doesn’t substantially lengthen the patient visit. And this doesn't even account for the significant time often wasted later, trying to rectify failed health initiatives that never gained traction due to a lack of effective initial communication.

We have seen the same in our vaccine communication work. Clinicians trained in motivational interviewing techniques—using open-ended questions and reflective listening—don’t spend more time discussing vaccines than those who weren’t trained. In some cases, they spend less.

The same communication principles apply in public health, where the community is the patient.

Like individuals, communities bring their own priorities, values, and concerns. And when we fail to listen, understand, and respond to those, we risk addressing nothing at all. Even when we correctly identify a community’s concerns, the instinct is often to tell them what they should care about or why their priorities are wrong. That approach rarely builds trust.

Here’s the bottom line—a twist on the Golden Rule: Don’t “should” onto others the way you wouldn’t want to be “should-ed” on.

So, back to my experience: when I learned this rural community didn’t see vaccines as a current priority, I could have launched into a list of why they should prioritize it. And yes, sometimes communities may not fully recognize how a particular health issue impacts them, and targeted, relevant education is warranted.

But instead of pushing, I listened. We talked about their priorities. And eventually, we found common ground. We aligned their priorities with mine, and paired vaccines with an issue the community already cared deeply about.

Had we forced a vaccine-only project on this community, it likely would’ve failed from poor engagement and lack of community buy-in. But by starting with their priorities, we built something together.

I won’t pretend this is easy. There are many barriers to doing this well, including limited time and resources and structural constraints. But here is one thing I have learned the hard way: It takes far more time and energy to rescue a failed project that never had community support than it does to build one with it from the start.

That experience taught me a critical lesson: If you don’t take the time to understand and support a community’s priorities, no one’s priorities will be met—not theirs, and not yours.

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Thanks for being part of this community.

-David

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