Storylines of family medicine V: ways of thinking-honing the therapeutic self.

is a 12-part series of thematically linked essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'V: ways of thinking-honing the therapeutic self', authors present the following sections: 'Reflective practice in action', 'The doctor as drug-Balint groups', 'Cultivating compassion', 'Towards a humanistic approach to doctoring', 'Intimacy in family medicine', 'The many faces of suffering', 'Transcending suffering' and 'The power of listening to stories.' May readers feel a deeper sense of their own therapeutic agency by reflecting on these essays.

A Comprehensive Clinical Model of Suffering.

Suffering is often a part of the illness experience, and relieving it is a fundamental obligation of medicine. Distress, injury, disease, and loss generate suffering when they threaten meaning in the patient's personal narrative. Family physicians have exceptional opportunities and responsibilities to manage suffering through long-term continuity relationships, demonstrating empathy, and building trust over time and across problems.

The Suffering Medical Students Attribute to Their Undergraduate Medical Education.

Background And Objectives: The purpose of this study was to explore medical student perceptions of their medical school teaching and learning about human suffering and their recommendations for teaching about suffering. During data collection, students also shared their percerptions of personal suffering which they attributed to their medical education.

Methods: In April through May 2015, we conducted focus groups involving a total of 51 students representing all four classes at two US medical schools.

A Narrative Approach to Healing Chronic Illness.

Many clinicians may feel poorly prepared to manage patient suffering resulting from the travails of chronic illness. This essay explores the thesis that chronically and terminally ill patients can be holistically healed by transcending the suffering occasioned by the degradations of their illnesses. Suffering is conveyed as a story and clinicians can encourage healing by co-constructing patients' illness stories.

Medical Student Perceptions of Their Education About Suffering.

Background And Objectives: To explore student perceptions of their medical school teaching and learning about human suffering and to elicit student recommendations for better approaches to teaching about suffering.

Methods: Qualitative study involving focus groups of students from each class at two US medical schools.

Results: Students reported that teaching about human suffering was variable, rarely explicit, and occurred primarily in the pre-clinical curriculum.

A philosophy for behavioral health integration in primary care.

In response to a call for a philosophy that transcends the professional boundaries that threaten behavioral health integration in primary care, this essay explores the thesis that such a philosophy exists in medicine's core purpose. Drawing on the work of Eric Cassell, a philosophy may be determined that melds the values, themes, and constructs of individual models for behavioral health integration in primary care toward a single, overriding purpose. Effecting such integration challenges current trends in medicine by refocusing medicine on its ethical core.

Medical student perceptions of medical school education about suffering: a multicenter pilot study.

Background And Objectives: Little is known about what students perceive they are taught about suffering in medical school. We sought to explore medical student perceptions of their medical school education about suffering.

Methods: We used an online survey of medical students enrolled in four US medical schools with chi-square analysis of responses by gender and preclinical/clinical status.

"I know this must have been a difficult day for you:" personal care in a patient-centered medical home.

In light of calls for a new model of care, family physicians are endeavoring to create a Patient-centered Medical Home. Yet, structures of care in themselves do not make a home; for the medical house to be a home requires physicians to demonstrate a personal touch that communicates caring to the patient. This essay describes one easily accomplished method by which to integrate personal care in a Patient-centered Medical Home.

Role modeling the doctor-patient relationship in the clinical curriculum.

Background And Objectives: Training in relationship skills relies heavily on role modeling: students observing clinicians at work. This study explored student and faculty perceptions of student learning about relationship skills in hospital and ambulatory settings.

Methods: Qualitative data from focus groups and long interviews were coded by the authors through an iterative dialogic process.

Medical trainee perceptions of medical school education about suffering: a pilot study.

Background: The relief of suffering is a fundamental goal of medicine, but what medical students are taught about suffering has been largely unexplored.

Objective: This pilot study explored the perceptions of physicians in postgraduate training of their medical school education about suffering.

Design: Survey research involving physicians in postgraduate family medicine training programs.

Faculty and medical students' perceptions of teaching and learning about the doctor-patient relationship.

Objective: To explore student and faculty perceptions of how students are learning doctor-patient relationship skills in their clinical medical education.

Methods: Exploratory qualitative study involving data from interviews and focus groups with students and interviews with teaching faculty.

Results: Respondents reported that pre-clinical relationship skills curricula were not well-coordinated with clinical curricula.

Suffering, meaning, and healing: challenges of contemporary medicine.

This essay explores the thesis that changes in contemporary society have transformed the work of doctoring and challenge doctors to be physician-healers. Medical advances in the prevention and management of acute disease have wrought a growing population of chronically ill patients whose care obliges physicians to become holistic healers. Holistic healing involves the transcendence of suffering.

The meaning of healing: transcending suffering.

Purpose: Medicine is traditionally considered a healing profession, but it has neither an operational definition of healing nor an explanation of its mechanisms beyond the physiological processes related to curing. The objective of this study was to determine a definition of healing that operationalizes its mechanisms and thereby identifies those repeatable actions that reliably assist physicians to promote holistic healing.

Methods: This study was a qualitative inquiry consisting of in-depth, open-ended, semistructured interviews with Drs.

Integrating communication training into a required family medicine clerkship.

Persistent evidence suggests that the communication skills of practicing physicians do not achieve desired goals of enhancing patient satisfaction, strengthening health outcomes and decreasing malpractice litigation. Stronger communication skills training during the clinical years of medical education might make use of an underutilized window of opportunity-students' clinical years-to instill basic and important skills. The authors describe the implementation of a novel curriculum to teach patient-centered communication skills during a required third-year, six-week family medicine clerkship.

Issues in end-of-life care: patient, caregiver, and clinician perceptions.

Context: Review of published research indicates the need to better incorporate patient and caregiver perceptions when providing end-of-life (EOL) care. Although considerable research regarding patient and caregiver experience of EOL has been done, little research has studied patients, caregivers, and clinicians as a connected system.

Objective: To study the perceptions of patients, caregivers, and physicians who are already connected with one another in an EOL care experience.

Defining effective clinician roles in end-of-life care.

Objective: Our goal was to determine primary care clinician perceptions of what is important to the provision of quality end-of-life care.

Study Design: We used ethnography, a qualitative research method involving the use of open-ended semistructured interviews.

Population: We included 38 family practice residency faculty from 9 community residency programs of the Affiliated Family Practice Residency Network, Department of Family Medicine, University of Washington School of Medicine.