More and more physicians are choosing employed practice over private practice to avoid the stresses of running an office and “just focus on patients.” But even employed practice has its challenges, from productivity demands to piles of paperwork, that can easily steal your attention away from your patients. In those moments when it feels like you are rushing from exam room to exam room or just going through the motions, pause and recite the following words: Be present.
Presence is a profound gift that family doctors can give their patients. It is more than being physically present; it is stepping into the sacred space of another person's world.
We have all experienced a patient encounter where we were distracted. We were technically present, but not authentically present. We sensed the disconnect, that feeling that something was missing in the encounter, and our patients likely sensed it as well. It's like a spouse who reads the paper at breakfast and, when accused by his wife of not listening, parrots what she just said but finds he's still in the doghouse because he didn't make her feel heard.
Authentic presence makes the other person feel heard, and it creates an emotional connection between human beings.
Here are some ways to practice being present with your patients:
1. Be intentional. Some physicians seem to have an innate ability to tune in to their patients, but for others this does not come as easily. Taking a moment to focus before entering the exam room and making a concentrated effort to be present and in the moment can be helpful. If you need help, post a sign on your office wall, write yourself a sticky note, or wear a rubber wrist band as a reminder to be present.
2. Be curious about the patient's agenda. In family medicine training, we often discuss the parallel tracks of the doctor's agenda and the patient's agenda. It is all too easy to rush through a visit pursuing your own agenda, but if you are fully present, you will ask about the patient's agenda as well. There has to be some give and take, some coming together of these parallel agendas, or the visit will not end in a satisfactory manner. (For more on this topic, see “Have You Really Addressed Your Patient's Concerns?” FPM, March 2008.)
3. Be careful with the use of technology. Most of us are still struggling with how to best use technology in the exam room. It seems that the more gadgets we have in the room with the patient, the less presence we have. Lap-tops and other technology, such as cell phones, can easily distract us from giving our full attention to each other. To keep technology from becoming a barrier to being present, engage the patient in what you are doing by talking out loud as you complete these tasks. (For more on this topic, see “EHRs in the Exam Room: Tips on Patient-Centered Care,” FPM, May 2006.)
4. Don't mistake familiarity with presence. We can know patients well and yet not be fully present with them. In fact, familiarity can sometimes cause us to function on autopilot, assume we know more about a patient than we actually do, or overlook factors that may be complicating the patient's illness. To guard against this, try asking the patient a new question – “How is your family?” “How do you feel about your illness?” or “Is anything else bothering you?” – to gain a new perspective.
5. Have a “ministry of presence.” The fields of pastoral care and counseling have made significant contributions to the concept of presence. For example, in pastoral care of the dying, my presence is sometimes all I can offer someone. Presence may or may not involve religious elements, but it often involves a spiritual connection. When you begin to view presence as a ministry, it can change your attitude and result in more compassionate care for the patient. Words may assist in communicating presence; however, presence transcends words.
6. Pay attention to feelings of disengagement. If you find that you are only physically present and going through the motions with patients, this is a warning sign of burnout. Pause and take note of what is going on in your life or career. For example, are you distracted at work because you are worried about something in your personal life or frustrated by something going on in your organization? Explore those issues and identify a first step you can take toward resolving them. (For more on this topic, see “Physician Burnout: Its Origin, Symptoms, and Five Main Causes,” FPM, September/October 2015.)
7. Practice, practice, practice. Being present is a habit you will have to cultivate until it becomes more routine. The good news is that practicing presence can be energizing. Being fully engaged and present with a patient is a much more rewarding way to practice medicine than the alternative. It can restore health and provide healing not only for the patient but for you as well.
Authentically being present with your patients is a wonderful gift to give them. Make sure to include it in your doctor's bag.