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What is clinician presence? A qualitative interview study comparing physician and non-physician insights about practices of human connection
  1. Cati Brown-Johnson, Research Scientist1,
  2. Rachel Schwartz, Health Services Research Fellow, Postdoctoral Fellow1,2,
  3. Amrapali Maitra, Resident Physician and Clinical Fellow in Medicine3,
  4. Marie C Haverfield, Assistant Professor4,
  5. Aaron Tierney, Research Assistant1,2,
  6. Jonathan G Shaw, Assistant Professor1,
  7. Dani L Zionts, Social Science Research Associate1,
  8. Nadia Safaeinili, Social Science Research Associate1,
  9. Sonoo Thadaney Israni, Executive Director5,6,
  10. Abraham Verghese, Professor5,6,
  11. Donna M Zulman, Associate Professor1,2
  1. 1 Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States
  2. 2 Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, United States
  3. 3 Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
  4. 4 Department of Communication Studies, San Jose State University, San Jose, California, United States
  5. 5 Presence Center, Stanford University School of Medicine, Stanford, California, United States
  6. 6 Department of Medicine, Stanford University School of Medicine, Stanford, California, United States
  1. Correspondence to Dr Cati Brown-Johnson; catibj{at}stanford.edu

Abstract

Objective We 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.

Design In 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.

Setting Physicians were recruited from primary care clinics in an academic medical centre, a Veterans Affairs clinic, and a federally qualified health centre.

Participants Participants were 55% men and 45% women; 40% were non-white.

Results Qualitative 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.

Conclusions Clinician 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.

  • physician-patient relationships
  • qualitative research
  • burnout
  • clinician presence
  • primary health care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors CBJ was involved in data collection and analysis. She also was the primary author of the manuscript. RS was involved in data collection and analysis. She also was a major contributor to writing the manuscript. AM was involved in data collection and analysis. She also was a primary contributor to the manuscript. MCH was involved in data collection and analysis. She also contributed significant edits to the manuscript. AT was involved in data collection and analysis. He also contributed significant edits to the manuscript. JGS was involved in research design, data collection, and also contributed significant edits to the manuscript. DLZ was involved in data collection and analysis. She also contributed significant edits to the manuscript. NS was involved in data collection and analysis. She also contributed significant edits to the manuscript. STI was involved in research design and also contributed significant edits to the manuscript. AV was involved in research design and also contributed significant edits to the manuscript. DMZ was involved in research design and data collection, and also contributed significant edits to the manuscript. All authors read and approved the final manuscript.

  • Funding This study was supported by a grant from the Gordon and Betty Moore Foundation (#6382). RS and MCH were supported by a VA Office of Academic Affairs Advanced Fellowship in Health Services Research. The views expressed herein are those of the authors and do not necessarily reflect the views of the Department of Veterans Affairs, the Gordon and Betty Moore Foundation, or Stanford University School of Medicine.

  • Competing interests CBJ reports grants from the Gordon and Betty Moore Foundation (#6382), during the conduct of the study. RS reports grants from the Gordon and Betty Moore Foundation (#6382) and VA Office of Academic Affairs Advanced Fellowship, during the conduct of the study. MCH reports grants from the Gordon and Betty Moore Foundation (#6382) and VA Office of Academic Affairs Advanced Fellowship, during the conduct of the study. AT reports grants from the Gordon and Betty Moore Foundation (#6382), during the conduct of the study. JGS reports grants from the Gordon and Betty Moore Foundation (#6382), during the conduct of the study. DLZ reports grants from the Gordon and Betty Moore Foundation (#6382), during the conduct of the study. NS reports grants from the Gordon and Betty Moore Foundation (#6382), during the conduct of the study. STI reports grants from the Gordon and Betty Moore Foundation (#6382), during the conduct of the study.She serves on the Board of Scients.org. She is not remunerated for this effort. AV reports grants from the Gordon and Betty Moore Foundation (#6382), during the conduct of the study. He also reports royalties from Knopf, Harper Collins, and Simon and Schuster; honoraria from the Leigh Speaker’s Bureau and the Health Policy Advisory Board for Gilead. DMZ reports grants from the Gordon and Betty Moore Foundation (#6382), during the conduct of the study.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was exempt for anonymous interviews with non-physicians by the Stanford IRB protocol 43314, 27 September 2017; and approval was granted for de-identified interviews with physicians as part of the Presence study by the Stanford IRB, protocol 42397, 26 October 2017.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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