Sunday, November 23, 2008
Churchill and Schenck from the Vanderbilt Center for Biomedical Ethics and Society published a paper in Annals of Internal Medicine that defines 8 themes for potential healing skills for medical practioners. As I read the list I immediately recognized some of these as basic tenets of good palliative medicine practice, which makes sense since a fair proportion of teaching in our field deals with self-care and avoiding burnout. But then I read the paper and realized it wasn't only about healing the practioner but rather healing the patient. The funny thing is it really works both ways. I guess my take on it tells you where my head was at when I read it. So here is the list:
- Do The Little Things
- Take Time and Listen
- Be Open
- Find Something to Like, to Love
- Remove Barriers
- Let the Patient Explain
- Share Authority
- Be Committed and Trustworthy
Do the Little Things
For me this has a lot to do with respect, trying a little harder to say a complicated name correctly, giving mouth care if you see a dry mouth instead of only considering it a finding on physical exam, finding a magazine on historical aircraft and giving it to the aviation buff, sitting down to talk to the patient. What are your 'little things' to do for patients?
Take Time and Listen
Do I need to tell you why this is second nature for palliative medicine? Being able to spend time with patients and families and not feeling that you have to drive the conversation is healing in both ways because it feels much more like a normal human relationship instead of just business. And sometimes that means a 90 minute family meeting.
This one might be a little more difficult for our field since being too open may be a recipe for burnout as we have talked about before on Pallimed. I think compared to other specialties, palliativists has more openness and vulnerability. So I don't necessarily advise trying to be more open; best to ask your colleagues who know you where your balance needs to lie.
Find Something to Like, to Love
Should you learn interviewing techniques to appear compassionate or should you just be interested in your patient. Finding things to like or to love about our patients and families comes naturally from the 2nd and 3rd topics fairly naturally. If you take time and listen, and are a little open to understanding a patient or family experience it is pretty easy to like something about them. Some may be harder or easier of course, but I think this is a result from the above.
Please add your own views on how these skills play into your practice. The second 4 are posted here.
HT: Joshua Schwimmer, MD - The Efficient MD
Larry R. Churchill, David Schenck (2008). Healing Skills for Medical Practice Annals of Internal Medicine, 149 (10), 720-724