When Stanford physicians Donna Zulman, MD, and Abraham Verghese, MD, set out more than two years ago to lead a team in finding ways to heal a growing fracture in doctor-patient relationships, they knew the task would be complicated.

In recent surveys, clinicians have reported that the current climate of medicine -- with limits on the amount of time they can spend with patients during appointments, an explosion of biomedical knowledge and increased demands to update and review electronic health records -- translates into less time for meaningful interactions with patients.

That, Stanford researchers contend in a paper to be published Jan. 7 in JAMA, isn't good for patients -- or for clinicians who are feeling increasingly disconnected from the reasons they got into medicine.
The goal of their research, which began 2½ years ago, was to identify evidence-based measures that clinicians can take to be fully engaged with patients and understand their perspectives, life circumstances and priorities. Ultimately, researchers wanted to generate a brief list of highly effective practices that clinicians could easily incorporate into their interactions with patients, Zulman said.

In their paper, researchers describe five evidence-based recommendations:

Prepare with intention: Familiarize yourself with the patient you are about to meet; create a ritual to focus your attention before a visit.
Listen intently and completely: Sit down, lean forward and position yourself to listen; don't interrupt; your patient is your most valuable source of information.
Agree on what matters most: Find out what your patient cares about and incorporate these priorities into the visit agenda.
Connect with the patient's story: Consider the circumstances that influence your patient's health; acknowledge your patient's efforts, and celebrate successes.
Explore emotional cues: Tune in, notice, name and validate your patient's emotions to become a trusted partner.
The research was conducted in conjunction with Presence, an interdisciplinary center at Stanford that promotes the art and science of human connection in medicine. The objective of the research project was to revise the critical moment when physicians and patients meet, shifting the emphasis from institutional procedure to an interaction focused on meaningful human interaction.

"We were looking for practices that would improve the experience of patients and lead to better care for them, but would also improve the experience of clinicians and help them to rediscover the joy of medicine," said Zulman, an assistant professor of medicine and the director of Stanford Presence 5, one of several Presence initiatives.

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