Care and competence in medical practice: Francis Peabody confronts Jason Posner

A Scoping Review on the Concept of Physician Caring

BACKGROUND

Physicians' interest in the health and well-being of their patients is a tenet of medical practice. Physicians' ability to act upon this interest by caring for and about their patients is central to high-quality clinical medicine and may affect burnout. To date, a strong theoretical and empirical understanding of physician caring does not exist. To establish a practical, evidence-based approach to improve health care delivery and potentially address physician burnout, we sought to identify and synthesize existing conceptual models, frameworks, and definitions of physician caring.

METHODS

We performed a scoping review on physician caring. In November 2019 and September 2020, we searched PubMed MEDLINE, Embase, PsycINFO, CINAHL, and CENTRAL Register of Controlled Trials to identify conceptual models, frameworks, and definitions of physician caring. Eligible articles involved discussion or study of care or caring among medical practitioners. We created a content summary and performed thematic analysis of extracted data.

RESULTS

Of 11,776 articles, we reviewed the full text of 297 articles; 61 articles met inclusion criteria. Commonly identified concepts referenced Peabody's "secret of care" and the ethics of care. In bioethics, caring is described as a virtue. Contradictions exist among concepts of caring, such as whether caring is an attitude, emotion, or behavior, and the role of relationship development. Thematic analysis of all concepts and definitions identified six aspects of physician caring: (1) relational aspects, (2) technical aspects, (3) physician attitudes and characteristics, (4) agency, (5) reciprocity, and (6) physician self-care.

DISCUSSION

Caring is instrumental to clinical medicine. However, scientific understanding of what constitutes caring from physicians is limited by contradictions across concepts. A unifying concept of physician caring does not yet exist. This review proposes six aspects of physician caring which can be used to develop evidence-based approaches to improve health care delivery and potentially mitigate physician burnout.

Compassion in healthcare: a concept analysis

Background

Compassion and compassionate care are central to radiographers’ professional policy and practice and are congruent with the core values of the National Health Service Constitution. The term compassion however is over-used, ambiguous and vague. This work sought to explore and provide contextual understanding to the term compassion in healthcare.

Method

Walker and Avant’s eight-step model was used as the framework for the concept analysis. Data collection utilised a number of resources including online databases: Medline, CINAHL complete, Scopus, PubMed, PsycINFO, ScienceDirect, Cochrane and DARE; dictionaries, social media, Internet sources, books and doctoral theses. In all, 296 resources were included in the review.

Results

The concept analysis distinguishes the defining characteristics of compassion within a healthcare context, allowing for associated meanings and behaviours to be outlined aiding understanding of compassion. Compassion in healthcare requires five defining attributes to be present: recognition, connection, altruistic desire, humanistic response and action.

Conclusion

The findings identify the complexity of the term and subjective nature in which it is displayed and in turn perceived. The concept analysis forms the basis of further research aiming to develop a healthcare explicit definition of compassion within healthcare, specifically cancer care and radiography practices. Lucidity will enhance understanding, facilitating active engagement and implementation into practice.

Begin with a text: teaching the poetics of medicine

This paper suggests that the purpose of humanities teaching within medical education should be primarily to teach and promote the informed, attentive, critical, and precise reading of the multiple texts that constitute medicine as a discursive field-in short, a poetics of medicine. This claim is illustrated by reconsidering Margaret Edson's play Wit, not as it is often used in medical education, as a cautionary tale about unprofessional behavior or as a way to inculcate "humanistic skills," but as an analysis of the relationships between texts and feelings-or cognition and emotion, or science and art. This reading is illustrated by comparing the poetics of Wit with those of two other texts representing ovarian cancer: a scientific paper in Oncology and a clinical case conference in JAMA.