By Alison Macartney
10th May, 2021
Alison Macartney has worked as a GP in Edinburgh for over 20 years. Prior to medicine Alison completed a degree in psychology. Her other interests include GP training, dementia, mental health, sleep and diabetes.
With all the changes in consulting that have come about due to the pandemic, I have been thinking more and more about what has been called the essence of general practice (1). In addition to clinical skills, it is clear that what patients value from their GP is the doctor patient relationship and the importance of the consultation.
In shared medical appointments, patients have also expressed views on liking more time with their health professional as well as the connections with peers. (2)
Many of us who are interested in lifestyle medicine are working in general practice and the strength of the clinician-patient relationship and the sense of connection can be an enormous advantage in discussing lifestyle interventions.
“General practice is a discipline in which the doctor patient relationship is the active ingredient of almost everything that is achieved. In such a relationship it is clear that the personal qualities of the doctor are complementary to the clinical skills.”. (1)
One of these qualities that underpin good relationships and connection is undoubtedly humility. Far from being a sign that someone is weak or too passive, true humility takes an enormous amount of confidence and self-awareness.
Humility has been shown to be a powerful quality in leadership and also a protective factor in burnout. But why is it so valuable in day to day consultations?
Firstly, it encourages CURIOSITY.
Edgar Schein is a former professor at M.I.T. and a specialist in organisational psychology. He coined the phrase ‘Humble Inquiry’ as a leadership skill. It summarises well what we are trying to achieve in a consultation. Humble Inquiry he defined as ‘the art of drawing someone out, of asking questions, building a relationship based on curiosity and an interest in the other person.’(3)
The significance of truly listening, both to fully understand and to demonstrate that understanding, is also a key part of this.
Secondly, it is non-judgemental.
Humility is the acceptance of our differences, and the awareness of our human similarities and vulnerabilities. Body shape and weight are examples of subjects that are too often ‘judged’, directly and indirectly, by the media, the medical profession and by society in general. With any lifestyle-associated condition comes the risk of shaming or being ashamed. Shame is a destructive, corrosive emotion and judgement only fuels shame.
Judgement can be heard in our words, seen in our facial expressions and read in our body language. (4) To avoid being judgemental we must know ourselves, and be aware of our biases, prejudices and privilege. (4)
Thirdly, it is empathetic.
Without humility, empathy becomes sympathy. What’s the difference?
In the words of Brene Brown “sympathy says – I’m over here and you are over there.”
‘Inherent in sympathy is “I don’t understand your world”. Empathy breaks down barriers. Sympathy is about separation; empathy is about connection’. (4)
Fourthly, it is the openness to work together – ‘joint decision making’.
Whether in a one to one consultation, or a group setting, it helps patients to make their own informed decisions. It allows people to work out their own solution, or to get ideas and strategies from discussion within the group, with the clinician having less and less importance in the room.
It is well summarised by the words of William Osler, who said in 1899, “Care more particularly for the individual patient than for the especial features of the disease”.
- Gillies J., Mercer S., et al Distilling the essence of general practice: a learning journey in progress. British Journal of General Practice 2009; 59 (562): e167-e176
- Schein E.H., Schein P.A., Humble Inquiry – the gentle art of asking instead of telling. 2nd edition. San Francisco. Berrett-Koehler
- Brown B., I thought it was just me (But it isn’t). New York. Avery. 2007