Feature Article: Practices to Foster Physician Presence and Connection with Patients in the Clinical Encounter - JAMA 2020

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I'm going to start featuring articles and interviews the might help Physicians, Providers and Caregivers reconnect with their inner passion for medicine, the things that drew them to patient care in the first place.  If you have ideas for things to feature, please let me know!

I recently heard Dr. Abraham Verghese talk about the ritual act of washing your hands prior to seeing a patient being "a reminder to leave the secular space and move into the sacred."  Reframing this simple act of infection prevention in patient safety has the potential to center us and offer presence.  It fits in nicely with number one below: 

      1) Prepare with intention (take a moment to prepare and focus before greeting a patient).

Take a look at the 5 recommendations this study came up with to foster physician presence and connection with patients in the clinical encounter.    

            Have you tried any of these suggestions?  

            Are you already doing them?  I know of you are already masters at this!

            Do you have other ideas that might work better?  

Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter.

Zulman DM, Haverfield MC, Shaw JG, Brown-Johnson CG, Schwartz R, Tierney AA, Zionts DL, Safaeinili N, Fischer M, Thadaney Israni S, Asch SM, Verghese A.

JAMA. 2020 Jan 7;323(1):70-81. doi: 10.1001/jama.2019.19003.PMID: 31910284

Link to Article      PubMed Citation

Abstract

Importance: Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction.

Objective: To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients.

Evidence review: Preliminary practices were derived through a systematic literature review (from January 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (-4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their "top 5" practices from among those with median ratings of at least +2 for all 3 criteria. Final recommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes.

Findings: The systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: 

1. Prepare with intention (take a moment to prepare and focus before greeting a patient); 
2. Listen intently and completely (sit down, lean forward, avoid interruptions); 
3. Agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); 
4. Connect with the patient's story (consider life circumstances that influence the patient's health; acknowledge positive efforts; celebrate successes); and
5. Explore emotional cues (notice, name, and validate the patient's emotions).

Conclusions and relevance: This mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.

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