Dagnone, Jeffery Damon

English

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Canadian	Medical	Education	Journal	2017,	8(4)		Correspondence:	J	Damon	Dagnone,	20	Barrie	Street,	Kingston,	ON,	K7L	3J6;	phone	:	613	533-6000	ext.	75276	email:	jdd1@queensu.ca	e97	Canadian	Medical	Education	Journal	Commentary	Commentary:	The	physician	as	person	framework:	How	human	nature	impacts	empathy,	depression,	burnout,	and	the	practice	of	medicine		J	Damon	Dagnone1		1Department	of	Emergency	Medicine,	Queen’s	University,	Ontario,	Canada	Published:	December	15,	2017	CMEJ	2017,	8(4):e97-e98		Available	at	http://www.cmej.ca	©	2017	Dagnone;	licensee	Synergies	Partners	This	is	an	Open	Journal	Systems	article	distributed	under	the	terms	of	the	Creative	Commons	Attribution	License	(http://creativecommons.org/licenses/by/2.0)	which	permits	unrestricted	use,	distribution,	and	reproduction	in	any	medium,	provided	the	original	work	is	properly	cited.		In	 this	 issue	 of	 CMEJ,	 Lester	 Liao	 presents	 a	theoretical	 framework	with	 five	 key	 components	 of	the	physician	as	person	and	advocates	for	additional	training	 opportunities	 for	 the	 integration	 of	 more	humanities	 training	 within	 medicine.1	 Let	 me	comment	as	a	physician	whose	life	and	professional	identity	 have	 been	 forever	 and	 unfathomably	transformed	through	and	by	a	tragic	event	in	my	life.	He	contends	that	not	only	is	separating	out	our	own	personal	life	experiences	not	possible	in	the	practice	of	 medicine,	 but	 is	 entirely	 inappropriate.	 I	 agree.	Authentic	 and	 personalized	 interactions	 are	 an	essential	 piece	 in	 caring	 for	 patients,	 whereby,	 the	interrelatedness	of	life	experiences	should	be	at	the	centre	 of	 relationship	 building	 and	 meaningful	connection	for	patients	and	physicians.	In	particular,	evidence2,3	 that	 suggests	 depression,	 burnout,	 and	declines	in	empathy	are	on	the	rise	demand	that	we	explore	 new	 perspectives	 of	 understanding.	 In	 this	article,	 the	 physician	 as	 person	 is	 more	 fully	recognized	 and	 core	 principles	 are	 put	 forward	 to	change	 the	way	we	 approach	 training	 physicians	 in	the	humanities,	which	has	implications	for	us	all.		The	 first	 principle	 of	 the	 physician	 as	 person	framework	states	that	encounters	with	patients	occur	primarily	between	two	people.	It	is	only	when	we	as	physicians	put	ourselves	in	“our	patient’s	shoes”	that	we	can	better	connect	with	them	on	a	more	human	level.	 This	 resonates	 with	 myself	 and	 many	 of	 my	colleagues,	as	many	of	us	have	become	much	better,	kinder,	and	more	caring	physicians	as	a	result	of	our	own	 healthcare	 experiences.	 Although	 medical	training	 teaches	 us	 how	 to	 meet	 the	 needs	 of	 our	patients,	 we	 actually	 learn	 more	 from	 our	experiences	 of	 life	 and	 must	 leverage	 our	 own	encounters	 to	 enhance	 the	 physician-patient	dynamic.	 My	 defining	 and	 life	 changing	 moment	came	when	my	three-year-old	son	died	from	cancer.	Today,	 not	 one	 shift	 goes	 by	 that	 my	 tragic	 life	experience	 hasn’t	 affected	 at	 least	 one	 patient	encounter	 on	 a	 daily	 basis.	 I	 am	 a	 different	 doctor	having	experienced	the	extreme	challenges	of	 living	in	hospital	with	a	critically	ill	child,	and,	following	his	death,	 continuing	 to	 struggle	 with	 the	 hole	 that	 is	forever	 in	my	 heart.	 Listening	 to	 patients’	 personal	stories	of	their	illness,	I	often	find	myself	sitting	on	the	Canadian	Medical	Education	Journal	2017,	8(4)		 e98	side	 of	 their	 ER	 bed	 trying	 to	make	 a	more	 human	connection	with	the	person	(the	patient)	beside	me.		The	second	principle	of	the	framework	speaks	to	the	interconnection	of	our	personal	and	professional	lives	and	 states	 that	 we	 should	 avoid	compartmentalization.	As	physicians,	 it	 is	unhealthy	to	be	a	different	person	 in	 the	professional	 context	than	who	we	are	in	the	personal	context.	It	is	also	not	natural	 or	wholesome,	 and	 yet	 it	 can	be	 frequently	found	as	an	insidious	and	powerful	part	of	physician	culture.	 Listening	 to	 patients,	 taking	 a	 history,	performing	 a	 physical	 exam,	 embarking	 on	 a	management	plan,	and	communicating	the	essential	parts	 of	 a	 clinical	 encounter	 must	 not	 be	 a	mechanistic	or	strictly	professional	interaction	that	is	separated	from	ourselves	as	people.	To	do	these	tasks	effectively,	 a	 humanistic	 approach	 that	 makes	 a	connection	with	the	person	 (the	patient)	 in	 front	of	you	 is	 what’s	 needed,	 and	 in	 my	 opinion,	 highly	valuable.	The	fourth	of	the	five	principles	exposes	the	aspect	of	our	 culture	 that	 hides	 vulnerability	 and	 reinforces	fictitious	 flawlessness.	 Each	 of	 us	 as	 physicians	 are	individually	 imperfect	 in	 the	 care	 that	 we	 provide.	This	has	always	been	the	case,	long	before	the	added	pressures	of	today’s	overcrowded	and	overburdened	healthcare	system	put	us	all	at	increased	risk	of	error	and	 overlooking	 or	 ignoring	 the	 individual	 needs	 of	patients.	 Whether	 it	 is	 due	 to	 errors	 in	 our	 own	diagnostic	 judgment,	 lack	 of	 access	 to	 resources,	therapeutics	 errors,	 inappropriately	 caring	 for	patients	in	hallways	or	corridors,	and	however	big	or	little,	 it	 is	 an	 impossible	 standard	 to	 uphold	flawlessness	–	and	yet	we	too	often	try.		It	is	difficult	to	speak	to	flawlessness,	and	not	consider	vulnerability.	 The	 power	 of	 being	 vulnerable,	 of	opening	 up	 and	 letting	 patients	 and	 colleagues	 see	your	imperfect	humanity	–	apologizing,	having	tears,	and	sharing	moments	of	pain	–	cannot	be	overstated	and	further	reinforces	the	physician	as	person.	It	is	no	coincidence	 that	 humanity	 and	 humility	 share	 the	same	Latin	roots.	Yes,	 it	 is	our	duty	as	physicians	to	care	 for	 our	 patients	 and	 focus	 on	 their	 needs,	 but	somehow	 in	 that	 commitment,	 we	 run	 the	 risk	 of	losing	 out	 on	 being	 able	 to	 communicate	 our	uncertainties,	 disappointments,	 failures,	 and	challenges.	As	a	bereaved	parent,	looking	back	at	my	experiences	in	hospital	years	ago,	the	most	powerful	connections	I	made	with	certain	doctors	was	in	large	part	due	to	their	ability	to	be	vulnerable	with	my	wife	and	me.	Towards	the	end	of	my	son’s	life,	they	did	not	have	 any	 answers	 and	 made	 some	 mistakes,	 and	because	they	were	vulnerable	with	us,	we	shared	the	burden	of	the	difficulties	together.	To	me,	there	is	no	other	way	to	approach	caring	for	patients	 than	 to	 leverage	 the	 human	interconnectedness	 in	 the	 patient-physician	interaction.	I	applaud	Lester	Liao	for	his	contribution	of	a	new	physician	as	person	framework	and	I	wonder	if	 this	 could	 be	 the	 start	 of	 a	 discussion	 for	 an	 8th	CanMEDS	role	or	the	addition	of	roots	and	a	stem!		References	1. Liao	 L.	 The	 physician	 as	 person	 framework:	 How	human	nature	impacts	empathy,	depression	burnout,	and	the	practive	of	medicine.	CMEJ.	2017;8(4):e94-8.	2. Delisle	M,	Rivard	J,	Hebbard	P,	McCarthy	B,	Wirtzfeld	D.	National	survey	of	mentorship	in	Canadian	general	surgery	residency	programs:	Where	are	we	and	what	do	we	need?	CMEJ.	2017;8(4):e42-53.	3. Bullock	 G,	 Kraft	 L,	 Amsden	 K,	 Gore	 W,	 Prengle	 B,	Wimsatt	J,	Ledbbetter	L,	Covingoton	K,	Goode	A.	The	prevelance	 and	 effect	 of	 burnout	 on	 graduate	healthcare	students.	CMEJ.	2017;8(3):e90-108.						

Commentary: The physician as person framework: How human nature impacts empathy, depression, burnout, and the practice of medicine

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Commentary: The physician as person framework: How human nature impacts empathy, depression, burnout, and the practice of medicine

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