I cannot think of a much better way to spend my last two weeks of elective time at Johns Hopkins School of Medicine than by being able to work with and observe the outstanding clinicians who are recognized by the Miller Coulson Academy. It is remarkable to be exposed to such a concentration of physicians who provide such positive role-modeling of the types of patient-centered care that I hope to emulate as I move on to residency. In particular, it was reassuring that even at a research-focused academic center like Hopkins, there are movements to recognize clinicians for clinical excellence in addition to academic success.
And so I'd like to share with anyone reading this entry a few of the "clinical excellence pearls" that I have picked up through my observations over the last few weeks. Some of these reinforce previous observations throughout medical school, and others are general rules that I've noticed are followed by those that I consider the best clinicians at Hopkins.
- The Goldilocks Principle: In other words, "not too much, not too little, but just right." I have found that the clinicians who are known for clinical excellence know how to give patients exactly what they need, which can change based on the clinical situation or patient's personality. I had the opportunity to observe some extremely skilled physicians, who knew how to tell when three or thirty minutes were needed, when more or less explanation was warranted, and when a patient needed direct guidance or lots of space; I only hope that I can learn how to sense what patients need throughout my professional development.
- Never Underestimate the Importance of Body Language: Without fail, every single one of the Miller Coulson Academy clinicians I was able to observe--from busy surgeons to outpatient medicine to inpatient palliative care--were masters of non-verbal communication. I observed small examples every day, such as turning a computer screen so that typing a note would not interfere with eye contact, leaning forward in a chair to communicate interest, and pausing from writing notes to focus solely on a patient's story. As an observer in these situations, I was further able to see patient reactions to these small gestures, which gave me a better understanding of how patient learn to trust their physician. One day soon, when I am an overwhelmed intern who has just started residency, I hope I can remember the impact of these simple adjustments so that I can learn to be more present with my patients.
- Preparation is Key...: I think as a medical student, it's sometimes hard to recognize the "behind the scenes" preparation that goes into patient care. I was often impressed by just how intimately the physicians that I worked with knew their patients stories. Often, even before seeing a patient, the physician would be anticipating the needs of the patient and planning the patient encounter.
- ...But Don’t Be Afraid to Go Off-Script: Despite what I said in the previous statement, there were definitely times where we would walk into a patient encounter expecting one scenario and be confronted by something completely different. I was able to observe, in these moments, how important it can be to sometimes change the plan to meet a patient's needs. The flexibility to respond to unexpected situations seems to be invaluable in patient-centered care.
- Medicine is a Team Sport: Physicians do not practice in isolation, and it was gratifying to see how well good clinicians interact with the other members of the clinical care team. There are many people involved in ensuring a good patient experience, and when the team is all on the same page, things tend to go much more smoothly. I was able to see interactions with PAs and NPs, with nursing or technical staff, and even with administration. Finally, I appreciated the many times that the patient, or the patients family, was given an active role in the care team, something I hope to emulate in my future practice.
Overall, these are just a few of the take-away points I was able to observe while working with some of the best clinicians at Johns Hopkins. The practice of medicine is an art, and there are many different ways to approach patient interactions. I can only hope that as I continue my training, I can build upon what I was able to learn during this elective in an attempt to provide my patients with the highest quality clinical experience.
Heather Walls, MSIV