Do you have a New Years’ resolution? I’m fairly certain some of you will have already made and broken one for the new year by the time you read this. If so, make a new one! And if you haven’t yet made a New Year’s resolution, here is a suggestion.
I came across a fascinating article about a year ago by Thomas Egnew, EdD. It deals directly with what we do daily in clinical practice—caring for patients. I hope you find the highlights striking enough to make a new resolution to replace the one you didn’t adhere to already, or to add to your list of resolutions.
The Magnificent Seven
Here are the seven skills for mastery of practice that the author refers to as “the magnificent seven:1
1. Take a moment to focus before you enter the examination room. It’s important to clear your mind from the last encounter or recharge after the morning’s tribulations. Then, it’s time to focus on the next patient. As Dr. Egnew stresses, becoming mindful of the details of the next patient outside the consultation room is a precursor to being mindful inside the examination room.
2. Establish a connection with the patient, develop rapport and agree on an agenda. This initial interaction gives you a chance to connect with the patient interpersonally and intellectually. Spending a small amount of time socializing and listening is a worthy investment. Also, set an agenda. You don’t need to address all of their concerns on the first visit, but be certain that they know you plan on addressing each concern or complaint to the best of your ability in the future.
3. Assess the patient’s response to illness and suffering. We must provide a precise diagnosis whenever possible. Dr. Egnew says that patients suffer in ways other than experiencing physical pain. We encounter patients with anterior and posterior segment anomalies that may not be painful physically but cause suffering from visual compromise.
4. Communicate to foster healing. Carl Rogers notes that anyone who counsels patients needs to display congruence (being authentic), acceptance (valuing the patient even if you don’t agree with their actions) and understanding (being sensitive to what they are experiencing). However, on occasion, we are forced into confrontation. For example, “You have thyroid eye disease—you must stop smoking!”
5. Use the power of touch. Of course, we do not recommend anything that can be misconstrued as an unwanted gesture, but this article recommends a warm handshake. If you get the sense that a patient is uncomfortable with any touch because of their cultural or religious beliefs, avoid it.
6. Laugh a little. “Humor can be helpful in establishing rapport, relieving anxiety, communicating a message that you care, enhancing healing and providing an acceptable outlet for any anger and frustration.” Gentle self-deprecation also has worked well for all of us from time to time.
7. Show some empathy. This is seldom practiced, especially as practitioners become somewhat hardened from our daily routine; we see so much pathology and visual loss that we run the risk of forgetting how devastating it can be. Dr. Egnew highlights the need for being explicit in your understanding of a patient’s problem; in doing so, it actually allows them to be more open in sharing both personal and clinically important information.
One way to incorporate these skills is to keep a list of patients you’ve seen over the past week who might benefit from a phone call to check on their progress. I’ve done this for years, and patients are always amazed that you have taken the time to call and are grateful for your concern. It goes a long way in saying, “I really care about you.” Of course, there’s some risk that it may get you more than you bargained for, but the pluses seem to always outweigh the minuses.
Many of these seven skills may seem straightforward and even obvious, but I find it always good to reflect on how your patients and their families might perceive you. Carefully reflecting on each of these areas should serve us all well to be better care providers. I thank Dr. Egnew for his seven skills to promote mastery in clinical practice. I hope you also find them helpful. And if this is one New Year’s resolution you can adopt—an attempt to master the art of practice—I hope it’s one you keep for the remainder of your career. Wishing all a happy and healthy New Year!
|1. Egnew TR. The art of medicine: seven skills that promote mastery. Fam Pract Mangag. 2014;21(4):25-30.|