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Three Patterns of Self Reflection from Physicians


In a study, physicians were asked to reflect on their communication with patients. Three themes seemed to emerge.

Researchers from Tufts University in Boston looked at private reflections of physicians on their communication with patients. The research team took the 756 reflections and grouped them into three themes that seemed to emerge from the self-study.

1. Recognizing the interdependence of physician-patient communication

Physicians were attentive to their own subjective feelings, thoughts, and rational (as well as irrational) responses to patients and how their methods of communication affected what patients shared, says Ashley Duggan, associate professor at Boston College in Chestnut Hill, Mass., and study co-author.

Randi Sokol, associate professor at Tufts Family Medicine Residency Program at Cambridge Health Alliance in Malden, Mass., provides an example of how a physician's approach can affect the approach of patients with addictions. "I am blunt and honest and accept them for who they are, which they are not necessarily used to experiencing," she says. "They, in turn, feel comfortable sharing things with me that they may not share with other physicians (e.g., how much/how often they are using drugs, if they are selling drugs, and so forth). Obviously this type of relationship is critical for the patient's buy-in and success in their recovery."

2. Attention to the subtleties of patient behavior

Physicians who could identify subtleties in patient behavior were able to better understand a patient's background, emotional cues, psychosocial information, and desires beyond medical care. This enabled them to recognize why they drew certain conclusions about patients. Physicians were able to identify what they overlooked regarding a patient's verbal and nonverbal cues about family, culture, and relationships. "For residents in the developmental stage, learning to broaden their scope is perhaps more valuable than getting it right initially," Duggan says.

Picking up on subtleties of a patient's behavior allows the physician to get to the root of what the patient is thinking and feeling, allowing the provider to meet the patient where that patient is (i.e., putting aside the physician's own agenda for the patient's agenda). "This in turn helps breed trust in the relationship, which eventually helps the patient achieve health goals," Sokol says.

3. Images of growth and awareness about physician-patient communication

When physicians reflect upon their growth, they can discover opportunities to improve upon mistakes, to better understand their clinical development, and to continue the learning process. Physicians who recognized communication missteps were also able to view communication as a personalized experience, allowing for meaningful exchanges with patients, Duggan says. Entries by student physicians showed that they were able to advance from simple, one-dimensional answers to multi-dimensional reactions that acknowledged opposing tensions. Physicians realized that multiple answers can better address patient needs, translating patient preferences and shared decision-making into more than one treatment option. Physicians were also thankful for the learning opportunities, appreciated the chance to reach new milestones, and realized that limitations can serve as opportunities for improving their understanding.

Sokol believes that physicians can grow to become more in tune with their patients' needs and learn to be more present in their interactions, which can be difficult in busy clinics when physicians are stressed for time and patients present a myriad of complaints relating to their psychosocial background. This requires physicians to pause and simply listen, which often breeds anxiety among busy clinicians.

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