Table 1
EMPATHY [2] (non-verbal practices that prioritize receptive power).
| APPROACH TO HUMANISTIC CARE DURING THE VISIT | WHAT IT MEANS IN A BUSY CLINICAL PRACTICE | HOW A PRECEPTOR CAN EXPLICITLY ROLE MODEL BEFORE THE ENCOUNTER | HOW A PRECEPTOR CAN GIVE FEEDBACK TO A TRAINEE AFTER THE ENCOUNTER |
|---|---|---|---|
| Eye Contact | Establishing and maintaining eye contact with the patient | ‘I position myself in the room such that I can maintain eye contact with the patient at all times and take notes only during pauses in the conversation.’ | ‘I noticed that you were typing notes when the patient’s mother frowned at a question you asked. Maintaining eye contact during the interview will allow you to notice non-verbal cues that may be worth addressing.’ |
| Muscles of facial expression | Keeping an open and relaxed face; subtle mirroring of patient expressions; nodding in affirmation; head tilting; furrowing of the brow to express concern, smiling to convey understanding/support | ‘I have found that mirroring emotions in the room, such as sadness and joy through my own facial expressions can demonstrate empathy.’ | ‘When the patient’s father questioned your recommendation to start antibiotics, I saw that your face tensed up. I am concerned that this may have affected your rapport building. What are your thoughts?’ |
| Posture | Sitting down to the level of the patient during verbal interactions; keeping arms uncrossed and relaxed; torso facing patient | ‘I am cognizant of how I position my arms as I talk to people. Crossing my arms across my chest has been mistaken in the past to be a sign that I am closed off from patients.’ | ‘I really appreciated how you got down onto the floor of the exam room and examined the patient as she was playing. Towering over children when we interact with them can be a scary experience for them.’ |
| Affect | Noticing patient affective cues and responding to them in a way that explores and validates expressed feelings | ‘When I sense strong emotions in the room, I try to name what I am sensing and ask for clarity to ensure that I am not misreading affective cues.’ | ‘Your humility in noticing and asking the patient’s mother if her tears were an expression of fear, sadness, or some other emotion, was laudable. It really opened up the healing process.’ |
| Tone of voice | Using a gentle, low pitched and unpressured voice | ‘I have received feedback that my slow and unpressured voice is calming to patients and so I make it a point to be consciously aware of how I am speaking.’ | ‘Did you notice that you were talking extremely fast during the patient visit? Let us talk more about that.’ |
| Hearing the whole patient | Aligning (‘coupling’) verbal and non-verbal responses to what the patient is conveying as a whole [11] | ‘In my experience patients’ facial expressions can often be misinterpreted. I have made it a practice now to mindfully observe patients’ body language in the context of their verbal communication, and even then, I practice humility and confirm if my understanding is accurate.’ | ‘I noticed that when the patient’s mother laughed, you smiled in response. I wonder, though, if her laughter was an expression of nervousness since we had just shared with them the uncertainty of her child’s medical diagnosis. What are your thoughts?’ |
| Your response | Practicing curiosity about one’s own responses (physical and affective) to the interaction using reflective practice [12] | ‘That was a challenging encounter for me, and I found myself getting irritated. I would really like to hear your thoughts on how you saw things during the visit.’ | ‘Let’s talk about what went well for you from an affective domain and what was a challenge during the last visit.’ |