Time constraints and administrative demands in health care often impede the human connection that is central to clinical care, contributing to physician burnout and patient dissatisfaction.
To improve clinical encounters with patients, physicians can learn from the Presence 5 project, which aims to develop a simple, scalable evidence-based intervention that helps enhance the patient-physician connection. The effort was described in detail in a JAMA article last year.
“The Presence 5 practices are intuitive to many clinicians, representing what is at the core of medical care and healing,” said Donna Zulman, MD, MS, assistant professor in the Division of Primary Care and Population Health at Stanford University School of Medicine, during a recent AMA webinar on fostering physician humanism and connection. “But in the context of today's busy medical practice with its endless distractions, adopting a ritual to explicitly focus on presence and connection can help build trusting relationships and can have a positive impact, not only on the patient, but on the clinician as well.”
Here are the five practices that have the potential to enhance physician presence and create meaningful connections with patients.
Prepare with intention
“This is about familiarizing yourself with the patient you are about to meet and creating a ritual to focus your attention,” said Dr. Zulman, who in addition to her role at Stanford is associate director of the Center for Innovation to Implementation at the Veterans Affairs Palo Alto Health Care System. “A specific strategy that can be helpful is to perform a brief chart review, emphasizing key elements of the social history, to remind yourself of the person you are about to see,” she added.
Listen intently and completely
“The goal of this practice is to position one’s self to fully hear a patient’s story and perspective,” said Dr. Zulman. That means “sit down, lean forward, position yourself to listen, recognizing that your patient is your most valuable source of information.”
“When it comes to nonverbal communication, thoughtful body positioning has been shown to support relationship building, trust and patient satisfaction,” she said. “If you need to be seated at a computer, position your body towards the patient as much as possible and avoid interrupting a patient.”
Agree on what matters most
“A simple form of this practice involves beginning the visit with an open-ended question such as, ‘What would you like to discuss today?’” said Dr. Zulman. “Then develop an agenda that incorporates the patient's priorities.
“At the end of the visit, you want to review the agenda and elicit any unaddressed priorities,” she added, noting that asking, “Is there something else you want to discuss today?” is particularly effective phrasing to elicit unaddressed concerns.
Connect with your patient’s story
“This practice is all about considering the social, cultural, behavioral circumstances that influence your patient’s health,” said Dr. Zulman. It’s also about “finding positive connections, acknowledging your patient’s efforts and celebrating success.”
“The first step is to be curious about your patient’s life story. This not only draws out important information that can guide your clinical care, but this mindset also can help you interrogate potential biases that you might have,” she said. “Use positive language, including statements of approval, reassurance and partnership.”
Explore emotional cues
“Notice, name and validate your patient's emotions to become a trusted partner,” said Dr. Zulman. “There's so much we can learn from tuning into a patient's verbal and nonverbal emotional cues such as changes in tone of voice, facial expressions and body language.
“One of our collaborators for this project talked about how she considers the patient's face to be a road map of emotion,” she added. “Ask your patient how they are feeling about their health concerns and stressors, and reflect, validate and confirm your perceptions of a patient's emotions.”
Learn more from the AMA STEPS Forward™ webinar series, which focuses on physician well-being, practice redesign and implementing telehealth during COVID-19.