In a systematic literature review of 73 studies, researchers from Stanford University and the VA Palo Alto Health Care System Center for Innovation to Implementation have looked at ways to improve the patient-physician connection.
Their work, “Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter,” appears in the January 7, 2020 edition of the Journal of the American Medical Association.
Donna Zulman, M.D., M.S., assistant professor in the Division of Primary Care and Population Health, Stanford University School of Medicine and an Investigator at the Center for Innovation to Implementation at the VA Palo Alto Health Care System, explained why physician-patient communication has become more difficult. “The climate of medicine today is very fast-paced. Physicians are under a lot of time and administrative pressure. In many cases, physicians interact with technology more than patients. All of this can prevent us from communicating in an intentional way and achieving the depth of understanding that is central to safe and effective clinical care, and—for many—is critical to a gratifying and sustaining career in medicine.”
“The objective of this project was to create an antidote to this by identifying evidence-based practices that are easy for physicians to adopt and will help facilitate meaningful interactions with their patients.”
Specifically, said Zulman, here are five basic recommendations that emerged from the study. “First, prepare with intention. The goal of this practice to is to prepare for a meaningful interaction, both physically and psychologically. Physical preparation depends on the clinical context, but at a minimum should include a brief (one-minute) chart review of critical medical and social history or in some settings a review of pre-visit questionnaire responses or medical assistant notes. Psychological preparation involves taking a moment to focus before a clinical interaction, for example by pausing at the door of an exam room and taking a deep breath to center one’s attention.”
“Second, listen intently and completely. The goal of this practice is to position oneself to fully hear a patient’s story and perspective. Specific actions include sitting down, leaning in, maintaining an open body position, and avoiding interruptions.”
“Third, agree on what matters most. The objective of this practice is to understand a patient’s health goals and priorities and incorporate this information into the visit agenda. Physicians can use an open-ended question such as, ‘How can I help you today?’ to elicit a patient’s goals, and then develop an agenda that incorporates the patient’s priorities using language such as, ‘I want to make sure we are on the same page about what you want to cover today. At the end of the visit, asking, ‘Is there something else you wanted to discuss today?’ will help elicit any unaddressed priorities.”
“Fourth, connect with the patient’s story. This practice focuses on understanding the circumstances that influence a patient’s health, and using positive, supportive language to form a connection. Approaches might include asking a patient what brings them joy, or identifying a shared experience such as a common hobby or life experience. Highlighting progress and obstacles that have been overcome can provide an opportunity to celebrate successes together.”
Lastly, explore emotional cues. “This practice involves tuning into a patient’s emotions by reading verbal and non-verbal cues, for example by making a conscious effort to read a patient’s facial expressions and body language. Importantly, physicians should also name and validate the patient’s emotion, for example by using language like, ‘That sounds very difficult,’ or ‘I can see that this is affecting you deeply.’”
As for how she hopes their work will enlighten clinical practice, Dr. Zulman said, “There are a lot of system-level and structural issues that impede meaningful interpersonal interactions in medicine right now. Even in this context, however, there are specific, purposeful practices that we as physicians can adopt to cultivate a greater connection and understanding with our patients.”
