What is clinician presence? A qualitative interview study comparing physician and non-physician insights about practices of human connection

• Published in: BMJ open 2019-11, Vol.9 (11), p.e030831-e030831
• Main Authors: Brown-Johnson, Cati, Schwartz, Rachel, Maitra, Amrapali, Haverfield, Marie C, Tierney, Aaron, Shaw, Jonathan G, Zionts, Dani L, Safaeinili, Nadia, Thadaney Israni, Sonoo, Verghese, Abraham, Zulman, Donna M
• Format: Article
• Language: English
• Subjects: Burnout; Communication; Design; Education; Empathy; Health care policy; Interviews; Medical research; Medicine; Occupations; Patient satisfaction; Patient-Centred Medicine; Physicians; Primary care; Psychology; Qualitative research
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-030831

ObjectiveWe sought to investigate the concept and practices of ‘clinician presence’, exploring how physicians and professionals create connection, engage in interpersonal interaction, and build trust with individuals across different circumstances and contexts.DesignIn 2017–2018, we conducted qualitative semistructured interviews with 10 physicians and 30 non-medical professionals from the fields of protective services, business, management, education, art/design/entertainment, social services, and legal/personal services.SettingPhysicians were recruited from primary care clinics in an academic medical centre, a Veterans Affairs clinic, and a federally qualified health centre.ParticipantsParticipants were 55% men and 45% women; 40% were non-white.ResultsQualitative analyses yielded a definition of presence as a purposeful practice of awareness, focus, and attention with the intent to understand and connect with individuals/patients. For both medical and non-medical professionals, creating presence requires managing and considering time and environmental factors; for physicians in particular, this includes managing and integrating technology. Listening was described as central to creating the state of being present. Within a clinic, presence might manifest as a physician listening without interrupting, focusing intentionally on the patient, taking brief re-centering breaks throughout a clinic day, and informing patients when attention must be redirected to administrative or technological demands.ConclusionsClinician presence involves learning to step back, pause, and be prepared to receive a patient’s story. Building on strategies from physicians and non-medical professionals, clinician presence is best enacted through purposeful intention to connect, conscious navigation of time, and proactive management of technology and the environment to focus attention on the patient. Everyday practice or ritual supporting these strategies could support physician self-care as well as physician-patient connection.