The Excellence Dividend

Excerpted with permission from Chapter 13 of  The Excellence Dividend by Tom Peters.


Jerome Groopman, a physician and Harvard med school professor, wrote How Doctors Think. He asserts that the key to collecting useful information and solving the patient’s health puzzle is to let the patient say her or his piece. Yet Groopman cites research that paints a rather sorry picture.


“The doctor interrupts the patient presenting her symptoms after …


Over to you dear reader: Are you an…

“18-second interrupter”??

The average doc, presumably, is like you or me—a pro who “knows what he’s talking about.” Hence, you (the patient) launch into your tale that brought you to the examining room, and in a flash, our medico has scoped the situation—and without missing a beat injects his ten- (or twenty five- or fifty-) cents worth.

Case closed.

Write the prescription.

“Next …”

Well, the odds are actually quite high that the doc has not properly scoped the problem. And even if he has more or less figured things out more or less correctly—he surely has not made the patient feel at the center of the process. The doctor has in fact in a beat marginalized the patient. It’s my game [doctor], not your game [patient].

Which is to say, we miss the whole d*nm point—which is:

(1) engagement and co-ownership of the issue—not to mention

(2) extracting useful information, which usually comes, not in a flash, but from an erratic back and forth process that allows a reasonably coherent story and a batch of new data to eventually emerge.

First step in your recovery from the “18-second syndrome”?

Own up to the hard/harsh fact that you most likely are one of the army of “18-second interrupters”—and, perhaps, with a nudge from this chapter, that you can, through hard and continuous study and practice and acceptance of feedback, do something about your “habit interuptis”—and in the process turn a glaring weakness into no less than a towering strength.


Language to deliberately consider:

F-I-E-R-C-E listening.

A-G-G-R-E-S-S-I-V-E listening.

These two words are extraordinarily important. Each is an action word. One tends to think of listening as a passive activity.




Listening is 100% about engaging—it is in fact the most emotionally intense of human activities.


I firmly believe that if, after a half-hour conversation, you are not exhausted … you were not seriously/fiercely/aggressively attentive.



A good listener:

  • Exists totally for the given conversation.  There is nothing else on earth of any importance to me for these [5, 10, 30] minutes.
  • Keeps her/his f*ing mouth shut.
  • Gives the other person time to stumble toward clarity without interruption. (A 10- or 20-second pause, a 45-second pause, when someone is thinking-beforetalking… is not an invitation to interrupt. D*MN IT.)
  • NEVER finishes the other person’s sentence.
  • Becomes INVISIBLE; makes the respondent the centerpiece.
    (My friend Dennis Littky, founder of Big Picture Learning, had an interesting habit—which my director once caught on film for a PBS show on leadership we were doing. He would enter, say, a tenth-grade classroom and go up to a student’s desk to chat. (Dennis was the principal of Thayer High School in Winchester, NH at the time.) When he got to the desk, he would reflexively get down on his knees so that he was looking up to the student. Talk about a change in the standard dynamic!)
  • Does not EVER take a call, even from her/his boss.
  • Takes (EXTENSIVE) notes.
  • CALLS(better than emails)  a couple of hours later to thank the other for her/his time.
  • Calls the next day with a couple of follow-up queries. 
  • Does NOT pontificate!



“Never miss a good chance to shut up.”  —Will Rogers



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4 responses to “The Excellence Dividend”

  1. Moe says:

    Thanks for the Article – Was good to read what i’m already trying to implement in my social life!

    What i’m often experiencing is that i’m trying to focus on what my opposite is telling me and then i sense that the person is looking somehow perplexed, leading to a strange dynamic where i try to continue by talking but then again i have that feeling that the opposite isn’t really listening or interested in what i’m saying. Sometimes i ask myself if it’s me who is maybe sending a signal where people might think i’m not interested at all, which i’m not. Any ideas?

  2. Flora says:

    Great article – I’m definitely guilty of interrupting and second guessing what the other person was about to say. For me, I find my anxiety in social situations is part to blame – I am anxious to keep the conversation going and don’t allow enough time to pass before jumping in. So despite being an introvert, and generally quiet person, I am a surprisingly bad listener!

  3. Gerold says:

    I’m an older male, but I once had a female doctor who surpassed all the male doctors I ever had.

    Thinking I had a brief window to explain, I wrote my speech ahead of time, rehearsed it and then rattled it off to her as fast as I could. She walked over and sat down in the chair beside me. My rapid-fire conversation immediately slowed to normal as she listened.

    It was only later I realized she did that deliberately to demonstrate she was willing to listen. It worked. She did.

    Unfortunately, I moved away a few years later and I’m back to ‘eighteen second’ doctors again.

  4. Joe Keleher says:

    Thank you for this article. I am a classroom teacher/introvert/highly sensitive person and find listening to be a skill almost foreign to my current students. As I will be interviewing for a language arts position this next week, I have been pondering the pieces missing in US current academics. I have tried to build listening skills by partnering students and having them question each other then quiz on what they have heard. I also have repeated the message of “hearing and listening are very different skills. You can hear the wind, but to listen means you have absorbed the message another passes in your direction.” As for myself, I continually practice my own listening skills and hope our common culture, including doctors, will someday value listening and understanding.

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