Anita D. Misra-Hebert, MD, FACP Project Leader Cleveland Clinic Funded by ABIM Foundation Putting The Charter Into Pract

1. Anita D. Misra-Hebert, MD, FACP Project Leader Cleveland Clinic Funded by ABIM Foundation Putting The Charter Into Practice Grant Program

2. Project Team • Anita D. Misra-Hebert, MD • Leonard Calabrese, DO • Alan Hull, MD, PhD • J. Harry Isaacson, MD • Martin Kohn, PhD • Mohammadreza Hojat, PhD (consultant) • Klara Papp, PhD( consultant, qualitative analysis)

3. Session Dates • Friday March 5, 2010 ( 4 hours) • Friday April 16, 2010(2 hours) • Friday June 11, 2010(2 hours) • Friday August 27, 2010 (2hours) • Friday October 15, 2010 ( 2 hours) • Friday December 10, 2010 ( 4 hours) All sessions will be eligible for CME credit

4. Session Topics • #1: Introduction to Reflective Writing/Narrative Medicine as a vehicle to increase Empathy, and Introduction to the Charter on Professionalism • #2: The Patient Experience of Suffering: The Other Side of the Bedrail • #3: Empathy Across Cultural Barriers • #4: Use of Literature to Increase Empathy • # 5: Empathic Communication of Treatment Plans: Health Literacy • #6: Empathy to Improve Health Care Quality

5. The teaching sessions • The 19 participants are divided into 4 groups and sit at a table with their groups. The group facilitators are Drs. Misra-Hebert, Calabrese, Hull, and Isaacson • Dr. Martin Kohn moves between groups in the role of an observer • Participants engage in reflective writing during the sessions and are asked to write prior to sessions 2 through 6. The writings are shared in the small groups.

6. Research: Quantitative • Jefferson Scale of Physician Empathy( JSPE) administered at first session to 19 participants and sent to 2 control groups. The survey was administered at the mid-point of the program( at August session) and planned at the end of the program. • Control Group 1 ( 10 physicians): receive readings for sessions only and complete surveys • Control Group 2 ( 10 physicians): complete surveys only

7. Research: Qualitative • Drs. Klara Papp and Martin Kohn will analyze the reflective writings for those participants who choose to turn them in ( IRB approved protocol) for general themes

8. Communication • A SharePoint site has been created through the College of Medicine for course participants. This site includes all course materials as well additional reference materials.

9. Our Hypothesis • We can advance professionalism by exploring and potentially increasing EMPATHY in the physician-patient encounter • Increasing empathy can support • the principle of primacy of patient welfare • the principle of social justice • the commitment to the quality of care

10. What is Empathy? • Hojat: “a predominantly cognitive attribute that involves an understanding of experiences, concerns and perspectives of another person, combined with a capacity to communicate this understanding.” • Coulehan: Doctrine of compassionate solidarity Hojat M.TenApprEnhancEmpatinHealandHumServCultJHHSASpring2009

11. Kleinman:Illness vs. Disease • Illness: “…the innately human experience of symptoms and suffering….Illness complaints are what patients and their families bring to the practitioner.” • Disease: “Disease…is what the practitioner creates in the recasting of illness in terms of theories of disorder…Disease is the problem from the practitioner’s perspective.” Kleinman A.TheIllnessNarratives.NewYork: BasicBooks, Inc1988.

12. Our Model Reflection Self-Awareness Empathy Implementation of Physician Charter

13. Session 1 • Presentation of the Charter • Discussion of definitions of empathy • Focus on Humanism as our goal • Dr. Jack Coulehan invited speaker (Professor Emeritus of Medicine and Senior Fellow of the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University) • In class reflective writing exercise asked to describe a situation when it was a challenge to be empathic

14. Feedback from Session 1 • Several senior faculty commented that they had shared stories through their reflective writing exercises that they had never shared before, one reporting how affirming it was to be part of a group • Several stories involved difficult patients, theme of empathy vs. emotional detachment • It was quite a challenge to break up the small group discussions at the end of the 4 hour session!

15. Session 2 • Discussion of Suffering from the patient’s perspective, and the “psychological transformation from citizen to patient” • Pre-session writing on an experience with patient suffering • Focus on bedside teaching skills incorporating empathic understanding of the patient’s point of view

16. Session 3 • Review of cross-cultural communication skills, exploring the role of discordance of health belief systems and the possible role of bias in a cross-cultural clinical encounter • Pre-session reflective writing about a time when you “felt different.” • In class reflective writing about a time when communication was difficult in a cross-cultural encounter

17. Session 4 • Participants chose a non-medical literary piece which resonated with them and wrote pre-session reflective writing on what the chosen piece meant to them • These submissions were created into a “script” by a guest writer/actor and were recited in the large group by the participants in a reader’s theater format

18. Thoughts about the future • Plans to expand this teaching program to practicing physicians in the region; current recruitment was only for Cleveland Clinic staff