Fall 2015

The Inner Life

Medical residents find value in reflecting on their interactions with patients

By Bruce Morgan

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Illustration: Marc Rosenthal

In medical residency, young doctors are often overwhelmed by all the fresh challenges that come their way, whether it’s applying the right bit of newly acquired knowledge to a case or remembering to ask the most pertinent question when encountering a patient for the first time. The chance for private reflection that may lead to their providing better medical care may be squeezed out in the daily rush.

Researchers at Tufts School of Medicine and Boston College have undertaken a joint strategy aimed at cultivating the habit of reflectiveness. The study directors asked 33 family-medicine residents enrolled in the Tufts program at Cambridge Health Alliance to write “open-ended reflections” that examined their interactions with patients over the course of a year. The project resulted in 756 personal reflections.

Sometimes the patient wanted the doctor to be a better listener. “This [teen] patient needed more trust and engagement. I wondered how I could have approached her better,” one resident wrote. In another case, a resident recalled a patient whom he informed that “these events could predict dementia. He looked at me blankly and said, ‘Events?’ I realized that I have to avoid BOTH jargon and ambiguous language.”

A second common failing that the new physicians recognized in themselves had to do with not getting to know the patient adequately before pressing ahead. “I wonder at what point I could have picked up the right clue that he was stressed and depressed by his family situation,” a resident wrote of one patient. Another resident recalled a personal stumble this way: “The patient’s fear and sadness about death was like a dagger to me. I grew defensive and tried to be jovial. It was hard to look him in the face . . . Today I felt helpless, overwhelmed, scared.”

Most residents reported that they came to know themselves better through the practice of introspection and vowed to adjust their former behaviors and beliefs. “I was surprised that there was more than one right answer,” one resident admitted. “I was worried that I was incompetent, but now I realize there are multiple right answers, and the situation and patient preferences make medicine more an art than I’d realized.”

Allen Shaughnessy, professor of public health and community medicine and director of the medical school’s Family Medicine Residency Program, is the senior author of the study, which was published in the July issue of the Journal of Health Communication.

Bruce Morgan can be reached at bruce.morgan@tufts.edu.

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