The Art of Medicine: Seven Skills That Promote Mastery
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With a little practice, these seven vital skills can become a natural part of your patient consultations.
Fam Pract Manag. 2014 Jul-Aug;21(4):25-30.
Author disclosure: no relevant financial affiliations disclosed.
Despite enormous advances in the science of medicine, the interpersonal encounter between patient and physician remains a keystone of medical care. Considerable research has explored various aspects of this relationship, including physician-patient communication, difficult patient interactions, and what physicians find meaningful in their work. These interpersonal aspects of the healing enterprise can be considered the art of medicine.
Most research into the art of medicine has tended to focus on theory instead of specifying how doctors should act. So, in teaching family medicine residents over the years, I have reviewed the literature and delineated seven behaviors that foster more consistent practice of the art of medicine. I call these behaviors “The Magnificent Seven.”
THE MAGNIFICENT SEVEN
Take a moment to focus before entering the consultation room.
Establish a connection with the patient by developing rapport and agreeing on an agenda.
Assess the patient's response to illness and suffering.
Communicate to foster healing.
Use the power of touch.
Laugh a little.
Show some empathy.
1. Focus on the patient. Before entering the consultation room, take a moment to personally prepare for the encounter. This will set the stage for all that is to follow. Become aware of what is going on in your body, whether you are feeling rushed or tense or are still thinking about the previous patient. If so, take a deep breath and let go of that tension or preoccupation so that you do not carry it into the next encounter.
Then, think about the patient you are about to see. What do you know about him or her? Where are you in terms of developing your relationship? What would you like to learn about this person that you don't already know? What is the topic of the encounter, if known, and how might that drive what needs to be accomplished during the consultation? Becoming mindful of these details outside the consultation room is a precursor to being mindful inside the consultation room.
2. Establish a connection with the patient. Use the first few minutes of the consultation to connect with the patient – before opening the electronic health record. Connection occurs on at least two levels: interpersonal and intellectual. Interpersonal contact is aimed at developing rapport and generally begins by incorporating a short, non-medical social interaction to open the interview. This is a good time to get to know a bit more about the patient. A good tactic is to refer to something mentioned in earlier consultations as a way to reinforce the continuity of your relationship, such as “How is your son doing?” or “How is your garden coming along?” When the patient answers, simply observe and listen, and you'll often find clues about his or her emotional state. Other aspects of interpersonal connection involve the effective use of attending behaviors that show you are listening, such as furthering responses (“uhhuh”), eye contact, and open body language. Spending a small amount
About the Authors
Thomas Egnew is a behavioral science coordinator for Tacoma Family Medicine, in Tacoma, Wash., and a clinical professor in the Department of Family Medicine, University of Washington School of Medicine, Seattle.
1. Gross DA, Zyzanski SJ, Borawski EA, Cebul RD, Stange KC. Patient satisfaction with time spent with their physician. J Fam Pract.1998;47(2):133–137.
2. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient's agenda: have we improved? JAMA.1999;281(3):283–287.
3. Mauksch LB, Dugdale DC, Dodson S, Epstein R. Relationship, communication and efficiency in the medical encounter: creating a clinical model from a literature review. Arch Intern Med.2008;168(13):1387–1395.
4. White J, Levinson W, Roter D. “Oh, by the way ...”: the closing moments of the medical visit. J Gen Intern Med. 1994;9(1):24–28.
5. Stewart MA, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-Centered Medicine: Transforming the Clinical Method. Thousand Oaks, Calif: Sage Publications; 1995.
6. Lang F, Floyd MR, Beine KL, Buck P. Sequenced questioning to elicit the patient's perspective on illness: effects on information disclosure, patient satisfaction, and time expenditure. Fam Med.2002;34(5):325–330.
7. Cassell EJ. The nature of suffering and the goals of medicine. N Engl J Med.1982;306(11):639–645.
8. Cassell EJ. Recognizing suffering. Hastings Cent Rep.1991;21(3):24–31.
9. McWhinney IR. Beyond diagnosis: an approach to the integration of behavioral science and clinical medicine. N Engl J Med.1972;287(8):384–387.
10. Rogers CR. The necessary and sufficient conditions of therapeutic personality change. J Consult Psychol.1957;21(2):95–103.
11. Rapaport MH, Schettler P, Bresee C. A preliminary study of the effects of repeated massage on hypothalamic-pituitary-adrenal and immune function in healthy individuals: a study of mechanisms of action and dosage. J Altern Complement Med.2012;18(8):789–797.
12. Herrington CJ, Chiodo LM. Human touch effectively and safely reduces pain in the newborn intensive care unit. Pain Manag Nurs.2014;15(1):107–115.
13. Wender RC. Humor in medicine. Prim Care.1996;23(1):141–154.
14. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med.2011;86(3):359–364.
15. Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu M. Practitioner empathy and the duration of the common cold. Fam Med.2009;41(7):494–501.
16. Spiro H. The practice of empathy. Acad Med.2009;84(9):1177–1179.
17. Stewart M, Brown JB, Boon H, Galajda J, Meredith L, Sangster M. Evidence on patient-doctor communication. Cancer Prev Control.1999;3(1):25–30.
18. Horowitz CR, Suchman AL, Branch WT Jr, Frankel RM. What do doctors find meaningful about their work? Ann Intern Med. 2003;138(9):772–775.
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