Good afternoon,
This is a Piece of My Mind from JAMA and a Faculty Development email.
Faculty, please save this to your Faculty Development Email folder.
This Piece, titled Primarily Care, is written by a primary care physician retiring after 40 years at Cambridge Hospital/Harvard Medical School.
https://jamanetwork.com/journals/jama/fullarticle/2758455
The author reflects on the highlights of a career well-practiced. In that reflection, the author provides us with an evidence base, his career experience, for the ACGME General Competencies of Patient Care and Interpersonal and Communication Skills. Here is a highlight:
“There are 3 things that I am most proud of in my career. They are not the articles I have written on the patient-physician relationship,
though I am proud of those. It is also not the unusual diagnoses I have made, though there is a certain thrill in recognizing
something obscure. I am most proud of 3 things that patients or their family members said to or about me.
The first was by a patient who said that unlike other physicians he saw, I never made him feel like I was rushing to catch a train.
The second was relayed to me by a colleague who shared a mutual patient. The patient told my colleague that when we were together,
I made the patient feel like the patient was the only other person in the world.
The third was from the son of an older immigrant patient who told me that he was proud to bring his father to see me because,
unlike many physicians in his home country, I treated his father with respect.”
The second article, Practices to Foster Physician Presence and Connection with Patients in the Clinical Encounter, is a systematic literature review (1997-2017) of practices used by physicians to engage with their patients.
https://jamanetwork.com/journals/jama/fullarticle/2758456
5 major practices were distilled from the analysis:
(1) prepare with intention
(2) listen intently and completely
(3) agree on what matters most
(4) connect with the patient’s story
(5) explore emotional cues
The article is an excellent guide. It is short and direct, meeting the MCHS faculty development goal of providing Simple, Efficient and Effective tools. For example, here is the article’s explanation for the 1st practice to prepare with intention:
“This practice includes 2 components that comprise physical and psychological preparation for a clinical encounter:
(1) personalized preparation for the patient and (2) taking a moment to pause and focus.
Notice how the evidence base of a literature analysis from a 20 year span, fits with the experience base of a physician with 40 years of practice.
Both forms of data inform us on best practices for engaging with our patients. Those practices are critical to training, to quality care and to how we evaluate ourselves. That’s why 2 of the 14 Common Questions in the Resident Evaluations of Faculty address this (#6 and #7: My attending showed respect to patients, other residents, colleagues and staff; My attending encouraged me to put the needs of patients first by being caring and sensitive to their specific needs.)
For Faculty: Please share and discuss these guidelines with your learners. Demonstrate use of the guidelines in your patient care and debrief with your learners afterward to make sure they noticed and valued it.
For Residents, Students: Practicing these now in training sets up a skill set that will benefit you and your patients throughout your career. As a result, many years from now as you reflect on your career, you could also write a Piece like this author did. And that benefits your well-being during and after your career.
Mike
Michael J. Schulein, Ph.D.
Resident Wellbeing Committee, chairperson
Division of Education