Advertisement

Humanism and Medical Treatment: Clinicians and Patients Finding Common Ground

  • Peter WeissmannEmail author
  • Alice Fornari
  • William T. BranchJr.
Chapter

Abstract

When formulating plans for medical treatment, the relationship between the clinician and patient is one of the most important variables that determines whether the plan will be adhered to and succeed. Elements of that relationship transcend the usual transactional nature of most professional encounters in daily life. One such element can be described by the professional attitude of the clinician as humanistic, a quality that can be distinguished from professionalism, that has received increasing attention from educational and professional leaders. Patients expect such an attitude from their providers. While it is sometimes assumed that “bedside manner” describes an innate quality, hard to describe, and that cannot be acquired, extensive literature demonstrates quite the opposite. The educational opportunities that foster a culture of medical humanism are often at odds with the healthcare environment that many learners and practitioners confront in daily practice, but intentional professional development can promote humanistic qualities in medical professionals to change the prevailing culture for the better. To do so, learners need to engage in self-reflection among a community of co-learners that is sustained over sufficient time, to create well-formed and well-intended role models that serve as a nidus for cultural change in the larger healthcare environment.

Keywords

Humanism Nonadherence Enhancing treatment adherence Clinician-patient relationship Shared decision-making 

References

  1. 1.
    Tosteson DC. Learning in medicine. N Engl J Med. 1979;301(13):690–4.CrossRefGoogle Scholar
  2. 2.
    Makoul G, Curry RH, Tang PC. The use of electronic medical records: communication patterns in outpatient encounters. J Am Med Inform Assoc. 2001;8(6):610–5.CrossRefGoogle Scholar
  3. 3.
    McGrath JM, Arar NH, Pugh JA. The influence of electronic medical record usage on nonverbal communication in the medical interview. Health Informatics J. 2007;13(2):105–18.CrossRefGoogle Scholar
  4. 4.
    Patel VL, Kushniruk AW, Yang S, Yale JF. Impact of a computer-based patient record system on data collection, knowledge organization, and reasoning. J Am Med Inform Assoc. 2000;7(6):569–85.CrossRefGoogle Scholar
  5. 5.
    Margalit RS, Roter D, Dunevant MA, Larson S, Reis S. Electronic medical record use and physician-patient communication: an observational study of Israeli primary care encounters. Patient Educ Couns. 2006;61(1):134–41.CrossRefGoogle Scholar
  6. 6.
    Frankel R, Altschuler A, George S, Kinsman J, Jimison H, Robertson NR, et al. Effects of exam-room computing on clinician-patient communication: a longitudinal qualitative study. J Gen Intern Med. 2005;20(8):677–82.CrossRefGoogle Scholar
  7. 7.
    Rouf E, Whittle J, Lu N, Schwartz MD. Computers in the exam room: differences in physician-patient interaction may be due to physician experience. J Gen Intern Med. 2007;22(1):43–8.CrossRefGoogle Scholar
  8. 8.
    Muller IR, Eldakar-Hein ST, Ames SE, Rosen LD, Urman RD, Tsai MH. Potential association between physician burnout rates and operating margins: specialty-specific analysis. J Med Pract Manage. 2017;32(4):233–8.PubMedGoogle Scholar
  9. 9.
    Sturm R. Effect of managed care and financing on practice constraints and career satisfaction in primary care. J Am Board Fam Pract. 2002;15(5):367–77.PubMedGoogle Scholar
  10. 10.
    Tingley K. Trying to put a value on the doctor-patient relationship. New York Times. 2018 May 16; Sect. Times Magazine.Google Scholar
  11. 11.
    Peabody FW. The care of the patient. JAMA. 1927;88(12):877–82.CrossRefGoogle Scholar
  12. 12.
    Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J Gen Intern Med. 2006;21(6):661–5.  https://doi.org/10.1111/j.1525-1497.2006.00399.x.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Fuertes JN, Mislowack A, Bennett J, Paul L, Gilbert TC, Fontan G, et al. The physician-patient working alliance. Patient Educ Couns. 2007;66(1):29–36.CrossRefGoogle Scholar
  14. 14.
    Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction. Patient Educ Couns. 2000;39(1):49–59.CrossRefGoogle Scholar
  15. 15.
    Suchman AL, Roter D, Green M, Lipkin M. Physician satisfaction with primary care office visits. Med Care. 1993;31(12):1083–92.CrossRefGoogle Scholar
  16. 16.
    An PG, Rabatin JS, Manwell LB, Linzer M, Brown RL, Schwartz MD. Burden of difficult encounters in primary care: data from the minimizing error, maximizing outcomes study. Arch Intern Med. 2009;169(4):410–4.  https://doi.org/10.1001/archinternmed.2008.549.CrossRefPubMedGoogle Scholar
  17. 17.
    Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277(7):553–9.CrossRefGoogle Scholar
  18. 18.
    Levinson W. Doctor-patient communication and medical malpractice: implications for pediatricians. Pediatr Ann. 1997;26(3):186–93.CrossRefGoogle Scholar
  19. 19.
    Levinson W. Physician-patient communication. A key to malpractice prevention. JAMA. 1994;272(20):1619–20.CrossRefGoogle Scholar
  20. 20.
    Baker LH, O’Connell D, Platt FW. “What else?” Setting the agenda for the clinical interview. Ann Intern Med. 2005;143(10):766–70.  https://doi.org/10.7326/0003-4819-143-10-200511150-00033.CrossRefPubMedGoogle Scholar
  21. 21.
    Mauksch LB, Dugdale DC, Dodson S, Epstein R. Relationship, communication, and efficiency in the medical encounter: creating a clinical model from a literature review. Arch Intern Med. 2008;168(13):1387–95.  https://doi.org/10.1001/archinte.168.13.1387.CrossRefPubMedGoogle Scholar
  22. 22.
    Heritage J, Robinson JD, Elliott MN, Beckett M, Wilkes M. Reducing patients’ unmet concerns in primary care: the difference one word can make. J Gen Intern Med. 2007;22(10):1429–33.  https://doi.org/10.1007/s11606-007-0279-0.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA. 1997;277(8):678–82.CrossRefGoogle Scholar
  24. 24.
    Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000;284(8):1021–7.CrossRefGoogle Scholar
  25. 25.
    DiMatteo MR, Hays RD, Prince LM. Relationship of physicians’ nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload. Health Psychol. 1986;5(6):581–94.CrossRefGoogle Scholar
  26. 26.
    Branch WT Jr, Frankel RM, Hafler JP, Weil AB, Gilligan MC, Litzelman DK, et al. A multi-institutional longitudinal faculty development program in humanism supports the professional development of faculty teachers. Acad Med. 2017;92(12):1680–6.  https://doi.org/10.1097/ACM.0000000000001940.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Cohen JJ. Viewpoint: linking professionalism to humanism: what it means, why it matters. Acad Med. 2007;82(11):1029–32.  https://doi.org/10.1097/01.ACM.0000285307.17430.74.CrossRefPubMedGoogle Scholar
  28. 28.
    Weissmann PF, Branch WT, Gracey CF, Haidet P, Frankel RM. Role modeling humanistic behavior: learning bedside manner from the experts. Acad Med. 2006;81(7):661–7.  https://doi.org/10.1097/01.ACM.0000232423.81299.fe. ß00001888-200607000-00017.CrossRefPubMedGoogle Scholar
  29. 29.
    Weissmann P, Haidet P, Branch WT, Gracey CF, Frankel R. Teaching humanism on the wards: what patients value in outstanding attending physicians. J Commun Healthc. 2010;3(3–4):290–9.Google Scholar
  30. 30.
    Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;63(606):e76–84.  https://doi.org/10.3399/bjgp13X660814.CrossRefPubMedGoogle Scholar
  31. 31.
    Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient. JAMA. 1997;278(6):502–9.CrossRefGoogle Scholar
  32. 32.
    Project Implicit: Harvard University. 2011. Available from: https://implicit.harvard.edu/implicit/.
  33. 33.
    Miller DP Jr, Spangler JG, Vitolins MZ, Davis SW, Ip EH, Marion GS, et al. Are medical students aware of their anti-obesity bias? Acad Med. 2013;88(7):978–82.  https://doi.org/10.1097/ACM.0b013e318294f817.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Waller T, Lampman C, Lupfer-Johnson G. Assessing bias against overweight individuals among nursing and psychology students: an implicit association test. J Clin Nurs. 2012;21(23–24):3504–12.  https://doi.org/10.1111/j.1365-2702.2012.04226.x.CrossRefPubMedGoogle Scholar
  35. 35.
    Burke SE, Dovidio JF, Przedworski JM, Hardeman RR, Perry SP, Phelan SM, et al. Do contact and empathy mitigate bias against gay and lesbian people among heterosexual first-year medical students? A report from the Medical Student CHANGE Study. Acad Med. 2015;90(5):645–51.  https://doi.org/10.1097/ACM.0000000000000661.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Oliver MN, Wells KM, Joy-Gaba JA, Hawkins CB, Nosek BA. Do physicians’ implicit views of African Americans affect clinical decision making? J Am Board Fam Med. 2014;27(2):177–88.  https://doi.org/10.3122/jabfm.2014.02.120314.CrossRefPubMedGoogle Scholar
  37. 37.
    Sabin JA, Marini M, Nosek BA. Implicit and explicit anti-fat bias among a large sample of medical doctors by BMI, race/ethnicity and gender. PLoS One. 2012;7(11):e48448.  https://doi.org/10.1371/journal.pone.0048448.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Jabben N, de Jong PJ, Kupka RW, Glashouwer KA, Nolen WA, Penninx BW. Implicit and explicit self-associations in bipolar disorder: a comparison with healthy controls and unipolar depressive disorder. Psychiatry Res. 2014;215(2):329–34.  https://doi.org/10.1016/j.psychres.2013.11.030.CrossRefPubMedGoogle Scholar
  39. 39.
    Phelan SM, Dovidio JF, Puhl RM, Burgess DJ, Nelson DB, Yeazel MW, et al. Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. Obesity (Silver Spring). 2014;22(4):1201–8.  https://doi.org/10.1002/oby.20687.CrossRefGoogle Scholar
  40. 40.
    Gonzalez CM, Kim MY, Marantz PR. Implicit bias and its relation to health disparities: a teaching program and survey of medical students. Teach Learn Med. 2014;26(1):64–71.  https://doi.org/10.1080/10401334.2013.857341.CrossRefPubMedGoogle Scholar
  41. 41.
    Hirsh AT, Hollingshead NA, Ashburn-Nardo L, Kroenke K. The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions. J Pain. 2015;16(6):558–68.  https://doi.org/10.1016/j.jpain.2015.03.003.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Sabin JA, Rivara FP, Greenwald AG. Physician implicit attitudes and stereotypes about race and quality of medical care. Med Care. 2008;46(7):678–85.  https://doi.org/10.1097/MLR.0b013e3181653d58.CrossRefPubMedGoogle Scholar
  43. 43.
    Sabin J, Nosek BA, Greenwald A, Rivara FP. Physicians’ implicit and explicit attitudes about race by MD race, ethnicity, and gender. J Health Care Poor Underserved. 2009;20(3):896–913.  https://doi.org/10.1353/hpu.0.0185.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Novack DH, Epstein RM, Paulsen RH. Toward creating physician-healers: fostering medical students’ self-awareness, personal growth, and well-being. Acad Med. 1999;74(5):516–20.CrossRefGoogle Scholar
  45. 45.
    Beach MC, Sugarman J, Johnson RL, Arbelaez JJ, Duggan PS, Cooper LA. Do patients treated with dignity report higher satisfaction, adherence, and receipt of preventive care? Ann Fam Med. 2005;3(4):331–8.  https://doi.org/10.1370/afm.328.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Adams JR, Drake RE. Shared decision-making and evidence-based practice. Community Ment Health J. 2006;42(1):87–105.  https://doi.org/10.1007/s10597-005-9005-8.CrossRefPubMedGoogle Scholar
  47. 47.
    Pinninti NR, Bokkala-Pinninti S. Shared decision making and humanistic care. Psychiatr Serv. 2007;58(3):414–5.  https://doi.org/10.1176/ps.2007.58.3.414.CrossRefPubMedGoogle Scholar
  48. 48.
    Elwyn G, Laitner S, Coulter A, Walker E, Watson P, Thomson R. Implementing shared decision making in the NHS. BMJ. 2010;341:c5146.  https://doi.org/10.1136/bmj.c5146.CrossRefPubMedGoogle Scholar
  49. 49.
    Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7.  https://doi.org/10.1007/s11606-012-2077-6.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Deegan PE, Drake RE. Shared decision making and medication management in the recovery process. Psychiatr Serv. 2006;57(11):1636–9.  https://doi.org/10.1176/ps.2006.57.11.1636.CrossRefPubMedGoogle Scholar
  51. 51.
    Vranceanu AM, Cooper C, Ring D. Integrating patient values into evidence-based practice: effective communication for shared decision-making. Hand Clin. 2009;25(1):83–96., , vii.  https://doi.org/10.1016/j.hcl.2008.09.003.CrossRefPubMedGoogle Scholar
  52. 52.
    Bauer AM, Parker MM, Schillinger D, Katon W, Adler N, Adams AS, et al. Associations between antidepressant adherence and shared decision-making, patient-provider trust, and communication among adults with diabetes: diabetes study of Northern California (DISTANCE). J Gen Intern Med. 2014;29(8):1139–47.  https://doi.org/10.1007/s11606-014-2845-6.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Hahn SR. Patient-centered communication to assess and enhance patient adherence to glaucoma medication. Ophthalmology. 2009;116(11 Suppl):S37–42.  https://doi.org/10.1016/j.ophtha.2009.06.023.CrossRefPubMedGoogle Scholar
  54. 54.
    Loh A, Simon D, Wills CE, Kriston L, Niebling W, Harter M. The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial. Patient Educ Couns. 2007;67(3):324–32.  https://doi.org/10.1016/j.pec.2007.03.023.CrossRefPubMedGoogle Scholar
  55. 55.
    Rivera-Spoljaric K, Halley M, Wilson SR. Shared clinician-patient decision-making about treatment of pediatric asthma: what do we know and how can we use it? Curr Opin Allergy Clin Immunol. 2014;14(2):161–7.  https://doi.org/10.1097/ACI.0000000000000046.CrossRefPubMedGoogle Scholar
  56. 56.
    Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;181(6):566–77.  https://doi.org/10.1164/rccm.200906-0907OC.CrossRefPubMedGoogle Scholar
  57. 57.
    Joosten EA, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CP, de Jong CA. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom. 2008;77(4):219–26.  https://doi.org/10.1159/000126073.CrossRefPubMedGoogle Scholar
  58. 58.
    Joseph-Williams N, Edwards A, Elwyn G. Power imbalance prevents shared decision making. BMJ. 2014;348:g3178.  https://doi.org/10.1136/bmj.g3178.CrossRefPubMedGoogle Scholar
  59. 59.
    Giguere A, Legare F, Grad R, Pluye P, Haynes RB, Cauchon M, et al. Decision boxes for clinicians to support evidence-based practice and shared decision making: the user experience. Implement Sci. 2012;7:72.  https://doi.org/10.1186/1748-5908-7-72.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Milner K, O’Connor M. Shared decision making and decision aids: an important part of evidence-based practice. J Nurs Educ. 2017;56(11):702–3.  https://doi.org/10.3928/01484834-20171020-14.CrossRefPubMedGoogle Scholar
  61. 61.
    Mayo Clinic Shared Decision Making National Resource Center: Mayo Clinic; [3.3.6.8.5]. Available from: https://shareddecisions.mayoclinic.org/.
  62. 62.
    Squier RW. A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships. Soc Sci Med. 1990;30(3):325–39.CrossRefGoogle Scholar
  63. 63.
  64. 64.
    Beaudoin C, Maheux B, Cote L, Des Marchais JE, Jean P, Berkson L. Clinical teachers as humanistic caregivers and educators: perceptions of senior clerks and second-year residents. CMAJ. 1998;159(7):765–9.PubMedPubMedCentralGoogle Scholar
  65. 65.
    Maheux B, Beaudoin C, Berkson L, Cote L, Des Marchais J, Jean P. Medical faculty as humanistic physicians and teachers: the perceptions of students at innovative and traditional medical schools. Med Educ. 2000;34(8):630–4.CrossRefGoogle Scholar
  66. 66.
    Kern DE, Branch WT Jr, Jackson JL, Brady DW, Feldman MD, Levinson W, et al. Teaching the psychosocial aspects of care in the clinical setting: practical recommendations. Acad Med. 2005;80(1):8–20.CrossRefGoogle Scholar
  67. 67.
    Branch WT, Arky RA, Woo B, Stoeckle JD, Levy DB, Taylor WC. Teaching medicine as a human experience: a patient-doctor relationship course for faculty and first-year medical students. Ann Intern Med. 1991;114(6):482–9.CrossRefGoogle Scholar
  68. 68.
    Platt FW. Empathy: can it be taught? Ann Intern Med. 1992;117(8):700; author reply 1.CrossRefGoogle Scholar
  69. 69.
    Cohen JJ, Clever LH, Collier VU, McCue JD, Markus A, Smith L. Who is sicker: patients – or residents? Residents’ distress and the care of patients. Ann Intern Med. 2002;136(5):394–5.CrossRefGoogle Scholar
  70. 70.
    Feudtner C, Christakis DA, Christakis NA. Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical environment and personal development. Acad Med. 1994;69(8):670–9.CrossRefGoogle Scholar
  71. 71.
    Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion and respect. Attending physicians’ responses to problematic behaviors. J Gen Intern Med. 1999;14(1):49–55.CrossRefGoogle Scholar
  72. 72.
    LaCombe MA. Recent advances. Am J Med. 1990;88(4):407–8.CrossRefGoogle Scholar
  73. 73.
    Branch WT, Kern DE, Haidet P, Weissmann P, Gracey CF, Mitchell G, et al. Teaching the human dimensions of care in clinical settings. JAMA. 2001;286(9):1067–74.CrossRefGoogle Scholar
  74. 74.
    Reuler JB, Nardone DA. Role modeling in medical education. West J Med. 1994;160(4):335–7.PubMedPubMedCentralGoogle Scholar
  75. 75.
    Wright SM, Kern DE, Kolodner K, Howard DM, Brancati FL. Attributes of excellent attending-physician role models. N Engl J Med. 1998;339(27):1986–93.CrossRefGoogle Scholar
  76. 76.
    Wright SM, Carrese JA. Which values do attending physicians try to pass on to house officers? Med Educ. 2001;35(10):941–5.CrossRefGoogle Scholar
  77. 77.
    Wright S, Wong A, Newill C. The impact of role models on medical students. J Gen Intern Med. 1997;12(1):53–6.CrossRefGoogle Scholar
  78. 78.
    Wright S. Examining what residents look for in their role models. Acad Med. 1996;71(3):290–2.CrossRefGoogle Scholar
  79. 79.
    Mentoring: what’s in it for both of us? Clin Teach. 2016;13(5):323–4.  https://doi.org/10.1111/tct.12573.
  80. 80.
    Steinert Y. Faculty development: from workshops to communities of practice. Med Teach. 2010;32(5):425–8.  https://doi.org/10.3109/01421591003677897.CrossRefPubMedGoogle Scholar
  81. 81.
    Wenger E. Communities of practice: learning, meaning, and identity. New York: Cambridge University Press; 1998.CrossRefGoogle Scholar
  82. 82.
    Branch WT. Teaching professional and humanistic values: suggestion for a practical and theoretical model. Patient Educ Couns. 2015;98(2):162–7.  https://doi.org/10.1016/j.pec.2014.10.022.CrossRefPubMedGoogle Scholar
  83. 83.
    Fornari A, Tortez LM, Lay M, Hirsch B, Tanzi D, Friedman I, et al. A mixed-methods approach to humanistic Interprofessional faculty development. J Contin Educ Health Prof. 2018;38(1):66–72.  https://doi.org/10.1097/CEH.0000000000000184.CrossRefPubMedGoogle Scholar
  84. 84.
    Branch WT Jr, Frankel R, Gracey CF, Haidet PM, Weissmann PF, Cantey P, et al. A good clinician and a caring person: longitudinal faculty development and the enhancement of the human dimensions of care. Acad Med. 2009;84(1):117–25.  https://doi.org/10.1097/ACM.0b013e3181900f8a00001888-200901000-00032.CrossRefPubMedGoogle Scholar
  85. 85.
    Branch WT, Pels RJ, Harper G, Calkins D, Forrow L, Mandell F, et al. A new educational approach for supporting the professional development of third-year medical students. J Gen Intern Med. 1995;10(12):691–4.CrossRefGoogle Scholar
  86. 86.
    Lipkin MJ, Kaplan C, Clark W, Novack D. Teaching medical interviewing: the Lipkin model. In: Lipkin M, Putnam S, Lazare A, editors. The medical interview: clinical care, education, and research. New York: Spring-Verlag; 1995. p. 422–35.CrossRefGoogle Scholar
  87. 87.
    Lipkin M. The medical interview and related skills. In: Branch WTJ, editor. Office practice of medicine. Philadelphia: WB Saunders Co.; 1994. p. 970–86.Google Scholar

Copyright information

©  Springer Nature Switzerland AG (outside the USA) 2019

Authors and Affiliations

  • Peter Weissmann
    • 1
    Email author
  • Alice Fornari
    • 2
    • 3
  • William T. BranchJr.
    • 4
  1. 1.University of Minnesota Medical SchoolMinneapolisUSA
  2. 2.Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadUSA
  3. 3.Northwell Health OrganizationNew Hyde ParkUSA
  4. 4.Division of General Internal Medicine and Geriatrics, Department of MedicineEmory University School of MedicineAtlantaUSA

Personalised recommendations