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Connecting with patients, detaching from outcome

October 10, 2017
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In a recent study authored by Janisse and colleagues, physicians rated highest in patient satisfaction described how they think about role and relationship with patients [1]. Each example offered in the article describes events that prompted and enabled transformed thinking, which resulted in improved communication and patient satisfaction.

One physician experienced significant mental/emotional energy drain from interacting with patients. To counteract the energy drain the physician was inclined to detach or choose not to connect with patients. This lack of attachment seemed to be the more objective approach. However, this kind of thinking changed when a respected colleague, serving as mentor helped change this thinking. The mentor reminded the physician that connecting with patients can be draining, but at the same time, it is nourishing.

Healthcare providers are all engaged in service to others. Service is draining. It involves taking time, effort, and energy to help someone else. But, service can also be satisfying and rewarding. Without some connection to the patient, it seems much more difficult to enjoy the satisfaction of service. The lack of connection robs patients of satisfaction, negatively influences outcomes, and denies providers of purpose.

In his book Clinical Reasoning in Spine Pain, Volume 1, Dr. Murphy describes this phenomenon from a slightly different, but insightful perspective [2]. Connecting with patients is a vital first step in establishing a healthy working relationship. Connecting means founding a relationship based on healing, beginning with accepting the patient as they are, not as the provider wants them to be. Focusing on patient personality traits, beliefs, habits, or other factors the provider wants to change results in frustration and can lead to animosity toward a patient. These feelings distract and prevent providers from fulfilling their purpose…to serve.

Dr. Murphy describes a cognitive process, sometimes called self-monitoring or reflection in action [3,4]. Self-monitoring in this instance is the process of being aware of one’s emotions or thoughts such that they can be objectively observed and set aside if unhelpful during a given situation. For example, a physician may believe, and for good reason, a patient should stop using tobacco. The provider, perhaps without realizing it and for noble purposes, alters the visit goal to that of tobacco cessation. However, this is not the patient’s visit goal. In this hypothetical scenario, focusing on tobacco cessation is a provider-centered activity and will likely result in both frustrated patient and provider.

I’m not suggesting tobacco use discussion be avoided in this hypothetical scenario. I am however, suggesting that self-monitoring and detaching from unhelpful thoughts or opinions can help place tobacco cessation and other discussions/visit goals in the proper context. By doing so, the patient’s purpose is addressed first and foremost.

Developing a perspective of service as giving of yourself, connecting with patients, establishing a healing relationship, developing self-monitoring skills, and learning to set aside provider-centric thoughts and emotions takes time and effort. I believe it is well worth it. As Dr. Murphy describes “By going through these steps, the practitioner will be in a position to accept the patient and establish a healing environment that is most conducive to patient benefit.”

Reference List
1. Janisse T, Tallman K: Can All Doctors Be Like This? Seven Stories of Communication Transformation Told by Physicians Rated Highest by Patients. Perm J 2017, 21.

2. Murphy DR: Primary management of low back disorders using the CRISP protocols. CRISP education and research, LLC; 2013.

3. Mezirow J: How critical reflection triggers transformative learning. Fostering critical reflection in adulthood 1990, 1: 20.

4. Taylor DC, Hamdy H: Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher 2013, 35: e1561-e1572.

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