The clinical encounter: an about-face?

Gradually, over the past decade we have been replacing face to face conversation with virtual interaction through cybervenues such as FaceTime and Facebook. Somehow, our social intercourse has not been not the same.

Face to Face. This slender volume rests on the bookshelf, a remnant from one of my graduate courses in counseling. The course was run as an encounter group. Participants had to work out the particulars of their interactions. Some of it was rough going; some of it wasn’t pleasant. You had to be an astute observer of body language, tone of voice, facial expression. Some of us were pretty adept at guarding our emotions; others wore their hearts on their sleeves. We didn’t necessarily agree with one another, but we heard one another out — at least, those of us who chose to interact.

In a group setting mutual support evolves through empathetic listening. To do so, you must be physically and psychologically present in the moment.

Similar interactions take place every day in the clinical encounter. We clinicians spend most of our day interacting with patients in the physical realm. With the advent and widespread use of the EMR (electronic medical record), face to face time has dwindled. Now the screen competes for our attention. No longer face to face with the patient, we tend to miss or overlook those subtle clues inherent in posture, facial expression, and body language.

Third-party payers are now advocating telemedicine as the latest and greatest means to improve access to healthcare and trim costs. In turning our eyes toward the future, might we actually be performing an about-face, as our physical face time recedes into the sphere of virtual reality?

A picture may be worth a thousand words, a video transcript even more; but I question the degree of meaningful healing that can take place in a virtual universe.

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Anticipatory guidance: Not just for patients

“There you had the opportunity to see what sometimes happens when we fail to provide proper anticipatory guidance to parents. Things devolve into disasters, and they’re much harder to fix.” more»

Interested readers can now access my latest Art of Medicine column — Anticipatory guidance: Not just for patients — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Humane Medicine pieces can now be accessed here.

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Like a small performance on the high wire, there’s an art to tightrope walking in clinical practice. more»

Interested readers can now access my latest Art of Medicine column — Tightrope — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Humane Medicine pieces can now be accessed here.

Philippe Petit on the wire

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In the clinical setting there are always hidden agendas. It takes an astute clinician to identify them. Many times students operate on a different wavelength entirely. Readers of the same novel will often come away with different takes on the narrative. Medical practice is no exception. more»

Interested readers can now access my latest Art of Medicine column — Hidden agendas — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Humane Medicine pieces can now be accessed here.

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As clinicians in primary care, much of our success depends directly upon how we relate to the patient. In most instances these relationships are built slowly over time. It is much more difficult to garner complete trust at the initial clinical encounter — difficult, but not impossible. more»

Interested readers can now access my latest Art of Medicine column — Selling yourself in primary care — recently published in the Journal of the American Academy of Physician Assistants.

Please note that all of my previously published Humane Medicine pieces can now be accessed here.