Read Young Doctors’ Reflections on Their Work

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Photo: Joos Mind/Getty Images

As anyone who’s ever been to the doctor can attest, when it comes to people skills, there’s huge variation within the medical profession. Some doctors effortlessly put their patients at ease, helping them along through difficult and scary times times with empathy and, when appropriate, humor; others make the situation worse by failing to connect emotionally, acting imperiously, or retreating into unhelpful medical jargon.

How do you nudge doctors from the latter category into the former? One potentially promising area is self-reflection, which, broadly speaking, means setting aside time to think about one’s beliefs and values and how they tie into past experiences and future goals. Since self-reflective writing exercises have shown some therapeutic promise, a team led by Dr. Ashley Duggan, a communications researcher at Boston College, asked 33 residents in the Tufts University Family Medicine program to complete three such exercises a week for a year, leading to 756 total entries.

This research, published in The Journal of Health Communication: International Perspectives, includes a bunch of excerpts from these exercises, some of which I’ll paste below. They make for fascinating reading, but the broader question here — and one this study can’t answer, because it isn’t designed to — is whether doctors who engage in these exercises will, over time, become better from a patient-communication perspective. It definitely seems like a ripe, promising area for future research.

Residents on moments when they didn’t perform at their best:

I got frustrated that everything too[k] longer in an appointment with a patient and an interpreter. I asked fewer questions and did not give the patient the same care that I give English-speaking patients.”

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. I don’t know if I will be able to handle this. I want to do palliative care because I think dying can be truly healing. Today I felt helpless, overwhelmed, scared.”

Residents on learning experiences:

I realized I should have eased into the harder questions, not going straight into asking a teen whether he had sex. My questions put him into too tight a space for sharing.”

I only asked about biomedical treatment, but of course the family wanted to take him to the temple so the monks could get rid of the spirits! I missed the core belief.”

Residents on moments they were proud of:

I noticed a need to present my patients’ options equally, spending time talking about each option, and to be careful of my intonation and eye contact so as not to imply what I think is best.”

Today I had a very rich and satisfying visit supporting a pregnant mom when I considered her needs more broadly in preparing for birth instead of just checking vitals and blood sugar.”

Residents on dealing with potential addiction in patients:

I can easily fall into the trap of assuming the worst in my patients, wondering whether pain is real or whether they are drug-seeking. The need to consciously remind myself feels like a moral dilemma.”

He may actually have bad pain, and I don’t intend to think of him as a system abuser. I can remember that patients might want something different than I am able to provide, and not draw conclusions.”