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Why should you always examine the patient?

In the second question in our two-minute question series Dr. Moyez Jiwa, host of the Health Design podcast asks if the clinical examination is a crucial part of the experience when visiting a doctor.

The respondents have all been featured in our podcasts. You an hear the longer conversations here:

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Making it more likely you’ll be heard doctor

Background Good communication skills are integral to successful doctor–patient relationships. Communication may be verbal or non-verbal, and touch is a significant component, which has received little attention in the primary care literature. Touch may be procedural (part of a clinical task) or expressive (contact unrelated to a procedure/examination).

Aim To explore GPs’ and patients’ experiences of using touch in consultations.

Design and setting Qualitative study in urban and semi-rural areas of north-west England.

Method Participating GPs recruited registered patients with whom they felt they had an ongoing relationship. Data were collected by semi-structured interviews and subjected to constant comparative qualitative analysis.

Results All participants described the importance of verbal and non-verbal communication in developing relationships. Expressive touch was suggested to improve communication quality by most GPs and all patients. GPs reported a lower threshold for using touch with older patients or those who were bereaved, and with patients of the same sex as themselves. All patient responders felt touch on the hand or forearm was appropriate. GPs described limits to using touch, with some responders rarely using anything other than procedural touch. In contrast, most patient responders believed expressive touch was acceptable, especially in situations of distress. All GP responders feared misinterpretation in their use of touch, but patients were keen that these concerns should not prevent doctors using expressive touch in consultations.

Conclusion Expressive touch improves interactions between GPs and patients. Increased educational emphasis on the conscious use of expressive touch would enhance clinical communication and, hence, perhaps patient wellbeing and care.

Simon Cocksedge, Bethan George, Sophie Renwick and Carolyn A Chew-Graham
British Journal of General Practice

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Your choices in medicine make the greatest difference

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The Art of Doctoring published on Jan 10th 2020

The book is available on Amazon

Moyez Jiwa, an experienced and thoughtful doctor, elevates with practical brilliance the lovely work that clinicians do. In sharp contrast to the grayness of industrial healthcare, he reimagines doctoring as performance art and proposes an elegant script to respond carefully to the suffering of each person. Bravo!

Victor Montori. Professor of Medicine at the Mayo Clinic in Rochester, Minnesota, USA.

Dr. Moyez Jiwa has written a practical guide for medical professionals to make authentic connections with their patients –and in doing so, spark enduring behavior changes that translate into better outcomes and happier lives. The Art of Doctoring left me feeling hopeful for the future of health care in a world where this book is on every provider’s shelf.

Amy Bucher, Ph.D., author of Engaged: Designing for Behavior Change and Vice President of Behavior Change Design at Mad*Pow

Behavior change is a complex science. Clinicians who desire to have lasting positive impact in their patients’ lives must consider the context of the each patient’s life. Successful, sustained health behavior change is driven by the individual [i.e. patient] who is ready for change, and The Art of Doctoring is written with an awareness of the role each patient plays in his or her own journey of living. The Theatre Model© is a brilliant way to frame a patient-provider encounter: Individuals choose who they enroll on their [health care] “theater cast” and how much influence, or how much of a role, each cast member will have. In addition, Jiwa calls out the paramount need for the office encounter to evolve and for the recognition that the patient be seen as “the most important person in the clinical encounter”. There exists a need for a board-certified coaches on the health care teams of the near future!

Nicole M. Guerton, MS, MCHES®, NBC-HWC, CIFT Wellness Coach | Mayo Clinic Department of Medicine | Healthy Living Program Assistant Professor of Health Care Administration | Instructor of Family Medicine

In his book The Art of Doctoring, Professor Moyez Jiwa has unlocked the secrets to creating better experiences for patients as well as the doctors who care for them. In each chapter, he uses very relatable patient stories to illustrate the art of doctoring and uses The Theatre Model© to skillfully peel back the curtain of medicine to reveal the essence of what it really means to be more than simply a good doctor, but to connect with your patient as healer. With more that 30 years’ experience, Jiwa is a leading voice in healthcare. This book is a must-read for anyone on the journey to unite both the science and art of medicine to create a better human experience.

Jake Poore, President and Chief Experience Officer, Integrated Loyalty Systems, Inc.
13538 Village Park Drive, Suite 120, Orlando, FL, USA 32837

Sir William Osler said that the practice of medicine is, “An art based in science.” Dr. Jiwa puts this into action in his book, The Art of Doctoring. He artfully describes how science can best inform a therapeutic ceremony that can be intentionally put into place to facilitate health in those we serve. He uses the best of science to teach the art. And what a wonderful artist he is. Anyone interested in cultivating their own healing arts would benefit from the wisdom this writing shares. I highly recommend it.

David Rakel, MD, Professor & Chair, University of New Mexico Dept of Family & Community Medicine, Author of, The Compassionate Connection.

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Making a diagnosis as a family doctor

The fact that it is often difficult or perhaps impossible to correlate the pathology and symptoms of coronary artery disease has led to a great deal of discussion and numerous explanations have been proposed.

Fred M Smith

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Do something in your power to make a difference

It’s a small detail. If you are accompanying someone down a corridor as a healthcare professional- don’t stride ahead. Ideally walk alongside the person or let them lead the way if they know where you are headed. If they are wheeling a buggy and carrying a bag offer to help by wheeling the buggy.  Just try it. You might like how they respond. Apart from that you can learn so much about the person even before the consultation begins:

So instead of a doctor assessing a patient’s blood pressure, body mass index, chronic conditions, hospitalization and smoking history and use of mobility aids to estimate survival, a lab assistant could simply time the patient walking a few meters and predict just as accurately the person’s likelihood of living five or 10 more years—as well as a median life expectancy. Scientific American

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