INTRODUCTION
The Calgary Cambridge Guide provides a structured framework for physicians to employ during the critically important patient medical interview. Its inception was designed to standardize a method for the interview that would ultimately result in formulation of a better assessment and plan. To do so, it incorporates an underpinned component of emotional awareness aimed to strengthen physician-patient rapport and trust. This in turn, combined with the framework aimed to streamline patient visits, improves patient trust and compliance. It addresses the patient’s emotional wellness in part by validating their feelings, making them feel physicians value their input and gives patients a sense of active participation in their health care. Essentially, it places the whole patient at the center of the visit, not the disease.
INTERNALIZATION OF THE PATIENT CENTERED APPROACH
The internalization of the patient-centered approach laid out by the Calgary Cambridge model has proven to be immensely beneficial in my day-to-day practice. In particular, allowing one of its core tenets, empathy, to frame my interpersonal interactions, has on more than one occasion, serendipitously manifested itself. Furthermore, I’ve found its application useful far beyond a simple philosophy of physician-patient interaction, employing it with my patient’s family members and loved ones, allied health staff, and other physicians and attendings, as well. There are a myriad constructive ways we physician may approach others throughout the day. Today’s modern, profit driven, high intensity health care model fosters a fast paced, high stress work environment. It is often devoid of the conventional ceremonies to convey politeness we are accustomed to in our personal lives. The veneer of congeniality we casually observe in other professions is all but non-existent in many health care settings.
TAKE A MOMENT…
With the aforementioned observations in mind, prior to entering each patient’s room, I take 5 seconds to breath, re-center myself, let go of any negative energy I may have been exposed to prior, smile and think aloud the word “Empathy” before I knock. This prepares me for whatever I may encounter from patients (and their families) on the other side of that door, curtain or phone line. It helps me better cope with their outward projection of emotions including fears, frustrations, fatigue, anger, etc. For the most part, it’s worked so far. The Calgary Cambridge model is much more than just an effective and clever way to extract information in an HPI and construct a well-informed DDx and assessment. A considerable amount of its power derives from the inherent acknowledgement of the necessity of compassion by the physician. Asking the patient about their expectations, questions, concerns and expressing empathy- speaks to an underlying expectation of kindness from the physician that goes toward treating the whole patient and not simply the acute disease.
APPLICATIONS BEYOND THE MEDICAL INTERVIEW
As stated earlier, I’ve found an adaptation of this philosophy has also helped my interactions with ancillary staff, residents, fellows and attendings as well. Taking a moment to apply empathy to these conversations has allowed me to improve department moral, strengthen interdepartmental relationships and even kindle a friendship or two.
Empathy should be applied bidirectionally whenever possible, however unfortunately seldom is. Pragmatically, empathy it is not a 2-way street, nor should anyone expect reciprocity when giving it. As mentioned above, we are all acutely aware of the frustrations which sometimes accompany working in health care. Long, arduous shifts. Difficult, non-compliant, combative, verbally/physically abusive patients. Abusive attendings. Abusive nurses. Abusive lab staff. Abusive… you get the point. These are the times when our training matters most. It is important to consider, the root cause of an individual’s poor response to an otherwise, seemingly benign occurrence. Stressing the importance of empathy wouldn’t be necessary if all of our patients were affable retired pharmacology professors who’s husband brings fresh baked cookies for the office on each visit. While rounding, an attending once shared with me his observation, “[We see most of these people on their worst days, when they are the most vulnerable, stressed, and fearful they’ve probably ever been]”. I like to remind myself of this whenever the fatigue starts to set in and my patience tank is nearing empty.
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Photo by National Cancer Institute on Unsplash
