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Getting the Most From Every Patient Encounter

How to Apply the Francis Commitment

Cleveland Francis, Jr., MD

Disclosures

August 11, 2022

In my previous blog, I introduced the Francis Commitment — a commitment I make to my patients to avoid any bias or racism on my part. It also works as a goal-setting tool to be used in every patient encounter. I have been asked by colleagues to expound.

1. I see you.

"I see you" has little to do with making eye contact. This vista comes from the heart and mind of the provider. Many patients feel invisible to clinicians. Are we looking at this person as a fellow human of equal status? What makes them different from the last patient — their educational level, their occupation? What about their family or where and how they live? What is their gender identity? How are these components affecting why they are seeking help?

2. I hear you.

Patients complain that their healthcare providers never listen to them and that they have little time to speak. Once a diagnosis has been made, many clinicians speak only to the disease and symptoms. How and why the patient feels a certain way appears unimportant. Our encounter should be a two-way conversation, not only us asking questions and giving orders. There is no equality under those circumstances.

We may be in a hurry, late to the appointment, and look like we want to get it over with as quickly as possible. This prevents patients who are hesitant to speak or who do not know what to ask from getting anywhere.

Even when rushed, we must make sure that we are present and not thinking ahead to the next patient. If we don't sit down or lift our eyes from the computer, it's as if we were never there.

Then there are those patients who have no desire to be there. They were cajoled into the appointment by a concerned family member. They may be waiting for you to ask the right questions. If you don't, you may never get to the bottom of what is wrong.

3. I accept who you are.

I consider this validation of the person you are treating. People usually know when we are uncomfortable with who they are. We must accept racial, religious, sexual orientation, or body differences and treat the patient in a manner that shows this. An example of poor form is meeting with a same-sex couple and addressing only the patient without acknowledging their partner.

It's a good idea to honestly review what your trigger points are: what characteristics automatically make you uneasy. Be aware of those.

4. I will try to understand how you must feel (empathy).

We have the capacity to walk in the shoes of others and we must make every effort to do so. This may help us elicit questions the patient is afraid or embarrassed to ask.

We may also come to understand that many patients have fears and anxieties that may not be obvious. With empathy we may be able to address these as we come to understand the impact of the disease process on the life of the patient.

Empathy is not synonymous with sympathy and it can be learned.

5. Treating you is very important to me.

Patients go out of their way to avoid troubling their doctors because they know that we are busy. They often view our profession as one of the most important in the world. We need to let them know that they are the reason we do what we do.

Patients are often shocked to receive a follow-up phone call from a doctor or a prompt answer when they call. It does not have to be the physician making the call; other members of the care team will suffice.

6. I would like to gain your trust that I will do my very best to make you better.

Trust is very hard to achieve in the absence of demonstrating the first five commitments.

Once trust and cooperation are established, treatment and compliance are much easier. Both the patient and the caregiver can begin to enjoy and take full advantage of future encounters.

7. I value you as a human being and will treat you as if you are family.

Validation is very important to all of us. We should show interest in the patient and ask questions about the patient's life. Treating a person like family does not mean that we share our cell phones or invite them to our home.

I made a promise that I would never send a patient to a colleague unless I would refer family or go to them myself. I made sure that my practice (the entire staff) would make life as easy for our patients as possible. A call from my office was as good as a call from me.

8. I care about what happens to you.

I openly express my concerns to the patient about where we are in the clinical journey and what I hope we can achieve. I review test results with them and entertain personal opinions if the patient presents them.

Be careful to avoid projecting that you do not care about what happens to the patient, perhaps by appearing rushed or ill prepared.

I once traveled with my wife to see a specialist. His office had requested a ton of labs and images that took us weeks to collect. We got to her appointment to find that the doctor had not even reviewed the information. He was asking questions about things he should have already known.

Being late can also project lack of caring. A patient should not have to wait 45 minutes for a doctor to stroll in as if nothing happened.

When late, I always apologize to the patient and give the reason for my lateness. We are often unaware of the huge effort it takes some patients to get to their appointments on time. It shows disrespect when we are late and do not even address it with the patient. If this appointment was essential to us, we'd be on time.

9. I want us to work together to fight this disease.

Let the patient know that they will not be alone. I tell them that their contribution is equally — and maybe even more — important. They are the ones doing the hard work day to day, such as changing habits and routines to improve their health. I will need their cooperation to be successful.

This usually results in a patient who complies with my recommendations because they have been empowered to participate in the treatment of their own disease.

10. I am grateful that you chose me as your caregiver.

I away tell my patients this. We are caregivers because of our years of specialized training, but without patients to treat, we are incomplete. It's akin to a pilot without a plane.

Our patients allow us to practice all that we have learned. If they trust us, we have a chance to play a significant role in the quality and length of their lives.

I always end my visits with a thank you to the patient. Some are taken aback and will say, "No, thank you."

Many colleagues complain to me that this takes time. It does not take nearly as much time as we think, especially if it becomes second nature.

Making the Commitment

Whether you're in private practice or part of a large organization, most care falls to the individual clinician in one-on-one encounters with patients. These things will not happen all at once and may take years of trial and error. Are you ready to make the Francis Commitment?

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About Dr Cleve Francis
Cleveland Francis, Jr., MD, Diversity, Equity and Inclusion Advisor; Inova Heart and Vascular Institute (IHVI), Falls Church, Virginia; Former president and founder, Mount Vernon Cardiology Associates; Chair, IHVI Committee on Equity, Healthcare Disparities, Education and Outreach; Member, Inova Inclusion Counsel

Dr Francis is also a songwriter and performer. He is a former recording artist on the Capitol Nashville Country Music Label (1992-1995), and his music has been featured at the National Museum of African American History and Culture in Washington, DC.

Connect with him:
Website: clevefrancis.com
Twitter: @muzicdoc2
Facebook: Cleve Francis
Instagram: @muzidoc

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