July 19, 2021

Teaching in the Clinic: Role Modeling and Being Aware of your Presence

Bruce Peyser, MD, FACP
Director of Education and Teaching, Duke Primary and Urgent Care
Physician, Duke Primary Care Pickett Road

Professor of Medicine, Duke University School of Medicine

I am sure it’s fairly obvious that when we teach we are serving as role models for our learners. They watch everything we do whether it relates to patient interviews, examinations, note writing, or collaborating with the staff. During these teaching times, we should be aware that we are “on stage” and be mindful of our presence in the clinic.

The importance of this sense of presence was explored recently in an article published in the Journal of the American Medical Association written by Abraham Verghese et al. It was entitled “Practices to Foster Physician Presence and Connection with Patients in the Clinical Encounter.”

I would not spend a lot of time exploring the methodology (this was a mixed-method study) but instead would focus on five items that can enhance and strengthen the connections we make with our patients.

These items are

  1. Prepare for the visit ahead of time with some purpose and intention.
  2. Listen to the patient carefully and completely, conveying this with our body language and avoiding interruptions.
  3. Determine with the patient what matters most.
  4. Connect with the patient’s story, especially focusing on the positive aspects and how the patient has been successful in the past.
  5. Explore the many emotional cues that are ever-present in our interactions with patients, and name them and validate them.

It’s hard to summarize this article, and I urge you to look at it in more detail. Since reading the article, I have started to practice these items, usually with learners present while I am seeing patients, and I am astounded at how a little bit of redirect and focus can strengthen the encounter.

Recently, I had a patient see me with many problems that felt a bit overwhelming to me. But when I asked the patient what he wanted to highlight and focus upon, the interaction became more narrow, and it was then relatively easy for me to help the patient achieve his short-term goal.

I intend to use these techniques more frequently, no matter whether I have a learner or not. Hopefully, you might find them useful as well.