|In an article published earlier this month in Academic Medicine, William T. Branch, Jr., MD, Carter Smith Sr. professor of medicine at the Emory University School of Medicine and director of the Division of General Internal Medicine at Grady Memorial Hospital, writes that respect is a core value of medical professionalism that physicians must strive to make an inner quality. Written from his personal viewpoint, Dr. Branch further notes that respect--which means to show esteem, regard, or honor to another person--receives less emphasis in medical education than other professional values, but is equally important and should permeate physicians' relationships with patients.
Dr. Branch says respect for patients is essential because it pervades physicians' interactions with patients, but much of the actions that convey respect are done by habit with "incomplete conscious awareness, and is therefore in danger of not being fully developed and expressed." Dr. Branch notes that respect is relatively, but not totally neglected in medical teaching. He says he wrote the article, Teaching Respect for Patients, to counterbalance the neglect.
"As physicians, we build healing, trusting relationships largely through the respect we convey to our patients," says Dr. Branch, who has written numerous articles on the topic of patient communications and bedside manner. "Respect may be manifested in many ways but is always an inner attitude that can be nurtured if not directly taught to trainees and medical students. To nurture means to set the right example, to be sure the example is noticed and influences our students, and to provide opportunities for students to reflect deeply on their work with patients so they are made fully aware of the respect for others that lies within themselves."
Dr. Branch notes that respect is often manifested in ways that reinforce a patient's dignity. Examples include addressing patients as "Mr." or "Ms.," rather than using their first names; asking permission before examining patients; sitting and making eye contact; paying close attention when patients speak; closing doors and curtains on rounds; and avoiding discussing patients with anyone not involved in their care. Non-intrusiveness and humility are other ways Dr. Branch says physicians can show respect for patients.
In the article, Dr. Branch says respect cannot be taught, but it can be nurtured in a student. He says respect can be accomplished by setting examples, giving medical students and residents opportunities to practice being respectful and most importantly, opportunities to think about their actions and become fully aware of the importance of respect of their own feelings and commitment to respect a patient. To create situations where physicians can learn respect for patients, Dr. Branch suggests that formal teaching exercises be conducted in the clinical setting; bedside teaching be done when opportunities arise; and critical reflection occur in small groups away from the clinical setting.
"This combination plumbs the depths of students' values and also puts values into practice," Dr. Branch writes.
Dr. Branch concludes the article by offering exercises to help students convey respect for patients. Eliciting the patient's story, for example, solidifies students' commitment to caring and humanistic interactions with patients. Demonstrating respect for patients' concerns on clinical rounds, on the other hand, helps medical faculty effectively role model respect to students. Lastly, Dr. Branch suggests deep critical reflection in the form of critical incident reports, narrative exercises and support and discussion groups as more ways to reinforce the importance of respect as an attitude that should be incorporated into every interaction with a patient.