Primary Care

5 Practices to Foster Patient-Clinician Connection

Following a systematic literature review, clinical observations, and qualitative interviews with physicians, patients, and nonmedical professions versed in intense interpersonal interactions, researchers have identified 5 recommended practices to “Foster presence and meaningful connection with patients.”

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For their evaluation, the researchers identified 73 studies, 67 of which were randomized controlled trials and 6 which were controlled observational studies, that reported on clinician-patient interpersonal interventions and included at least one of the following outcomes: patient health outcomes, patient experience, clinician experience, and cost.

Further, 27 physician-patient interactions in 3 primary care settings (academic medical center, Veterans Affairs facility, and federally qualified health center) were observed. Those observed had been identified as “having exceptional interpersonal skills” and were diverse in terms of race/ethnicity, years of experience, and gender.

Lastly, 30 professionals from outside of the medical field with professions involving “intense interpersonal interactions,” including management; business/finance; community and social service; educational instruction; arts, design, entertainment, and media; protective services; and personal care and service occupations, were interviewed in an attempt to identify cross-disciplinary practices that could be applicable in the health care field.

Following their analysis, the researchers developed a list of 31 potential practices, which, following an evidence review and the use of a modified Delphi process, they revised and finalized a list of 5 recommended practices:

  • Prepare With Intention: This includes personalized preparation for the next patient and taking a moment before the appointment to clear the mind of distractions and focus on the patient.
  • Listen Intently and Completely: A clinician should listen with open and receptive body language and avoid interrupting the patient.
  • Agree on What Matters Most: A clinician should identify what matters most to a patient and develop shared priorities for the visit.
  • Connect With the Patient’s Story: This includes considering personal circumstances influencing a patient’s health and focusing on acknowledging a patients efforts and celebrating their successes.
  • Explore Emotional Cues: A clinician should read a patient’s verbal and nonverbal emotional cues, elicit patient emotion through questions, and reflect upon and validate perceptions of a patients emotions (eg, I can see that this is affecting you deeply”).

“Human connection remains central to medicine but is in jeopardy in the current health care environment. In an era of increasing reliance on technology for health records, diagnosis, and treatment, recognizing and prioritizing the value of human connection and care are crucial. We identified practices grounded in scientific evidence that have the potential to foster physician presence and improve the experience of clinicians and patients,” the researchers concluded.

—Michael Potts

Reference:

Zulman DM, Haverfield MC, Shaw JG, et al. Practices to foster physician presence and connection with patients in the clinical encounter [published online January 7, 2020]. JAMA. 2020;323(1):70-81. doi:10.1001/jama.2019.19003.