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August 13, 1997, Vol 278, No. 6 >
ARTICLE | August 13, 1997

Calibrating the Physician: Title and subTitle BreakPersonal Awareness and Effective Patient Care FREE

Dennis H. Novack, MD; Anthony L. Suchman, MD; William Clark, MD; Ronald M. Epstein, MD; Eva Najberg, MSc; Craig Kaplan, MD
[+] Author Affiliations

Additional participants in the Working Group on Promoting Physician Personal Awareness are listed at the end of this article.

Reprints: Dennis H. Novack, MD, Division of Medical Education. MCP-Hahnemann School of Medicine, Allegheny University of the Health Sciences, 2900 Queen Lane, Philadelphia, PA 19129.


JAMA. 1997;278(6):502-509. doi:10.1001/jama.1997.03550060078040
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References

Physicians' personal characteristics, their past experiences, values, attitudes, and biases can have important effects on communication with patients; being aware of these characteristics can enhance communication. Because medical training and continuing education programs rarely undertake an organized approach to promoting personal awareness, we propose a "curriculum" of 4 core topics for reflection and discussion. The topics are physicians' beliefs and attitudes, physicians' feelings and emotional responses in patient care, challenging clinical situations, and physician self-care. We present examples of organized activities that can promote physician personal awareness such as support groups, Balint groups, and discussions of meaningful experiences in medicine. Experience with these activities suggests that through enhancing personal awareness physicians can improve their clinical care and increase satisfaction with work, relationships, and themselves.

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Levinson W, Roter DL, Mulloly JP, Dull VT, Frankel RM.  Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons . JAMA . 1997;;277:553-559.
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Beckman HB, Markakis KM, Suchman AL, Frankel RM.  The doctor-patient relationship and malpractice: lessons from plaintiff depositions . Arch Intern Med . 1994;;154:1365-1370.
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Nightingale SD, Grant M.  Risk preference and decision making in critical care situations . Chest . 1988;;93:684-687.
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Dimsdale J.  Delays and slips in medical diagnosis . Perspect Biol Med . 1984;;27:213-220.
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Nightingale SD.  Risk preference and laboratory test selection . J Gen Intern Med . 1987;;2:25-28.
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Zinn WM.  Transference phenomena in medical practice:being whom the patient needs . Ann Intern Med . 1990;;113:293-298.
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Suchman AL, Markakis K, Beckman HB, Frankel R.  A model of empathic communication in the medical interview . JAMA . 1997;;277:678-682.
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Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Novack DH.  Therapeutic aspects of the clinical encounter . J Gen Intern Med . 1987;;2:346-355.
2 +
Epstein RM, Campbell TL, Cohen-Cole SA, McWhinney IR, Smilkstein G.  Perspectives on patient-doctor communication . J Fam Pract . 1993;;37:377-388.
3 +
Mengel MB.  Physician ineffectiveness due to family-of-origin issues . Fam Syst Med . 1987;;5:176-190.
4 +
Lipkin M Jr, Lazare A, Putnam S. The Medical Interview . New York, NY:Springer-Verlag NY Inc; 1995;.
5 +
Schechter GP, Blank L, Godwin HA, La Combe MA, Novak DH, Rosse WF.  Refocusing on history-taking skills during internal medicine training . Am J Med . 1996;;101:210-216.
6 +
Carter WB, Inui TS, Kukull WA, Haigh VH.  Outcome-based doctor-patient interaction analysis, I: comparison of techniques . Med Care . 1982;;20:535-549.
7 +
Simpson M, Buckman R, Stewart M, et al.  Doctor-patient communication: the Toronto Consensus Statement . BMJ . 1991;;303:1385-1387.
8 +
Levinson W, Roter DL, Mulloly JP, Dull VT, Frankel RM.  Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons . JAMA . 1997;;277:553-559.
9 +
Beckman HB, Markakis KM, Suchman AL, Frankel RM.  The doctor-patient relationship and malpractice: lessons from plaintiff depositions . Arch Intern Med . 1994;;154:1365-1370.
10 +
Nightingale SD, Yarnold PR, Greenberg MS.  Sympathy, empathy, and physician resource utilization . J Gen Intern Med . 1991;;6:420-423.
11 +
Nightingale SD, Grant M.  Risk preference and decision making in critical care situations . Chest . 1988;;93:684-687.
12 +
Yarnold PR, Nightingale SD, Currex RH, Martin GJ.  Psychological androgyny and preference for intubation in a hypothetical case of end-stage lung disease . Med Decis Making . 1990;;10:215-222.
13 +
Dimsdale J.  Delays and slips in medical diagnosis . Perspect Biol Med . 1984;;27:213-220.
14 +
Nightingale SD.  Risk preference and laboratory test selection . J Gen Intern Med . 1987;;2:25-28.
15 +
Murray HA. Explorations in Personality . New York, NY: Oxford University Press Inc; 1938;:36-141.
16 +
McDaniel SH, Campbell TL, Seaburn B.  Managing personal and professional boundaries: how to make the physician's own issue aresource in patient care . Fam Syst Med . 1989;;7:1-12.
17 +
Zinn WM.  Transference phenomena in medical practice:being whom the patient needs . Ann Intern Med . 1990;;113:293-298.
18 +
Erikson EH. Childhood and Society . New York, NY: WW Norton & Co Inc; 1963;:247-274.
19 +
Vaillant GE, Bond MP, Vaillant CO.  An empirically validated hierarchy of defense mechanisms . Arch Gen Psychiatry . 1986;;43:786-794.
20 +
Shapiro D. Neurotic Styles . New York, NY: Basic Books Inc Publishers; 1965;:1-23.
21 +
Suchman AL, Markakis K, Beckman HB, Frankel R.  A model of empathic communication in the medical interview . JAMA . 1997;;277:678-682.
22 +
Marshall AA, Smith RC.  Physicians' emotional reactions to patients: recognizing and managing countertransference . Am J' Gastroenterol . 1995;;90:4-8.
23 +
Bennett G. The Wound and the Doctor:Healing, Technology and Power in Modern Medicine . London, United Kingdom: Seeker & Warburg; 1987;:246-247.
24 +
Balint M. The Doctor, His Patient, and the Illness . New York, NY: International University Press; 1972;.
25 +
Longhurst M.  Physician self-awareness: the neglected insight . Can Med Assoc J . 1988;;139:121-124.
26 +
 Self-awareness as a formal component of the curriculum . Arch Intern Med . 1969;;124:385-386.
27 +
Gorlin R, Zucker HD.  Physicians' reaction to patients: a key to teaching humanistic medicine . N Engl J Med . 1983;;308:1059-1063.
28 +
Quill TE, Williamson PR.  Healthy approaches to physician stress . Arch Intern Med . 1990;;150:1857-1861.
29 +
Williamson PR.  Support groups: an important aspect of physician education . J Gen Intern Med . 1992;;6:179-180.
30 +
Novack DH, Volk G, Drossman DA, Lipkin M Jr.  Medical interviewing and interpersonal skills teaching in US medical schools: progress, problems, and promise . JAMA 1993;;269:2101-2105.
31 +
Kern DE, Grayson M, Barker LR, et al.  Residency training in interviewing skills and the psychosocial domain of medical practice . J Gen Intern Med . 1989;;4:421-431.
32 +
McCue JD.  The effects of stress on physicians and their medical practice . N Engl J Med . 1982;;306:458-463.
33 +
McCue JD.  Influence of medical and preclinical education on important personal qualities of physicians . Am J Med . 1985;;78:985-991.
34 +
McKegney CP.  Medical education: a neglectful and abusive family system . Fam Med . 1989;;21:452-457.
35 +
Martin AR.  Stress in residency: a challenge to personal growth . J Gen Intern Med . 1986;;1:252-257.
36 +
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37 +
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To understand the clinical management of acute heart failure syndromes.
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