Anita D. Misra-Hebert, MD, FACP
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Anita D. Misra-Hebert, MD, FACP Project Leader Cleveland Clinic Funded by ABIM Foundation Putting The Charter Into Practice Grant Program. Project Team. Anita D. Misra-Hebert, MD Leonard Calabrese, DO Alan Hull, MD, PhD J. Harry Isaacson, MD Martin Kohn, PhD

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Anita D. Misra-Hebert, MD, FACP

Project Leader

Cleveland Clinic

Funded by ABIM Foundation Putting The Charter Into Practice Grant Program

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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)

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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

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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

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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.

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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

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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

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  • 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.

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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

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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

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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.

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Our Model




Implementation of Physician Charter

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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

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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!

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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

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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

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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

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Thoughts about the future

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