Lucy Goodchild explores the findings and attention around a piece of research published in the previous month that caught the public’s attention. Listen to the accompanying podcast here.
If you’ve ever left the doctor’s office feeling unheard, you’re not alone. The challenges of the medical profession have eroded the connection between patient and doctor in many cases, and this could be having a negative impact on people’s health.
The average doctor in the US works 60 hours a week, enduring pressure from administrative tasks, technology distractions and packed schedules. “All of this can create an environment where we don’t have a lot of time for meaningful conversations with patients,” said Dr. Donna Zulman, a primary care physician and Assistant Professor of Medicine at Stanford in the US.
Yet connecting meaningfully with patients is at the core of medicine, and it’s something patients need in order to benefit fully from their medical care. Working with colleagues at Stanford, Dr. Zulman set out to improve care by re-engaging doctors and patients. The result, published in JAMA, is a set of five evidence-based recommendations that are easy to implement.
Read the paper: https://jamanetwork.com/journals/jama/article-abstract/2758456
“One of our goals here was to try to understand how to foster humanism in the clinical encounter, but within the context of this very busy day-to-day practice that we know exists,” Dr. Zulman said. “We wanted to bring to light the evidence-based strategies that clinicians can use that will help improve both their own experience with their patients’ care, and the patients’ experience as well.”
In their study, Dr. Zulman and the team started with a systematic review of the literature. They found 20,000 papers on effective interpersonal interventions, and they narrowed the collection down to 73 high-quality studies, which they analyzed.
Next, they observed doctors and patients in three different clinics, and interviewed them about the things clinicians did to support meaningful interactions. Finally, they interviewed people from a range of non-medical professions, gathering insights about interpersonal interactions from teachers, chaplains and even firefighters.
Five approaches every doctor can take
With evidence from the literature review, observations and interviews, they took a long list of strategies to a panel of experts – doctors and researchers who looked through everything together to determine which strategies would be most effective. The result is a set of five recommendations for doctors.
- Prepare with intention – take a moment to prepare and focus before greeting a patient
- Listen intently and completely – sit down, lean forward, avoid interruptions
- Agree on what matters most – find out what the patient cares about and incorporate these priorities into the visit agenda
- Connect with the patient’s story – consider life circumstances that influence the patient’s health; acknowledge positive efforts; celebrate successes
- Explore emotional cues – notice, name, and validate the patient’s emotions
As a primary care physician, Dr. Zulman was of course first in line to test out the recommendations. “The first one, preparing with intention, I found to be extremely helpful – to take a moment to focus my attention before I meet with a patient, to be completely focused on the person I’m talking to and clear my mind of distractions. I’m also giving a lot more attention to how my body is positioned in the room, how I’m listening to the patient, making sure that I’m fully listening and engaged, and avoiding interruptions.”
When analyzing the evidence, the team wanted to make sure they identified practices that doctors could use in the context of the challenging environment in which they’re working, so they had to be things that wouldn’t double the time needed for an appointment, for example. “I think using just a few seconds to prepare oneself before a conversation doesn’t take time and it can make a huge difference to that interaction,” Dr. Zulman explained.
A few, she says, may be trickier for doctors to take on board. Some may be hesitant to really engage with patients’ stories and emotional cues out of concern that they might be starting down a long path. But according to research, the opposite is the case – with meaningful connection, patients feel listened to and they are more likely to express concerns early on.
The team is now in the process of developing materials for residents, medical students and nurses to bring the practices to a wider audience. And after examining what doctors can do to improve their connections with patients, the next step will be to look at how the system can be changed to do the same thing.
Although the field research was done in the US, the literature review was global, and Dr. Zulman believes the work will resonate globally. “I anticipate that there will be some cross-cultural adaptations that need to be made for the practices to make sense in specific settings, but we have seen that clinicians are posting the practices on their computers or on the wall so that they can refer to them and remind themselves of them before seeing patients.”
Reaching practicing doctors through (social) media
The paper was published in JAMA on 7 January 2020, and by the end of February it had already surpassed 15,000 views. Attention on social media and in the news have helped – and the paper’s Altmetric attention score of around 1300 reflects the global activity surrounding the paper, particularly by doctors on Twitter.
Discover the coverage: https://www.altmetric.com/details/73716746?src=bookmarklet
“I think clinicians are seeking to reconnect with this part of the profession that’s so important to us, connecting with patients, and so I think the topic really resonates,” Dr. Zulman said. “Our hope is that it’s a very practical set of tools that clinicians can easily adopt, that they can teach to their residents and medical students.”
Anticipating that the topic would be popular among practicing doctors, Dr. Zulman contacted the Stanford press office before the paper was published and they worked together on a press release – something she recommends others do in similar situations. “That was a really great partnership and opportunity to help get the word out about the paper,” she said.
Dr. Zulman’s top tip for promoting research
“Because it focuses on this human connection, this is a topic that pretty naturally resonates with people. In other cases, research might need to be digested a bit more in a way that will reach a wider group. That’s where I think it can be very helpful to work with somebody in the press office at your institution to think about what messages are going to take off best and resonate with that wider audience.”