Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 3134-3146 |
| Number of pages | 13 |
| Journal | Journal of general internal medicine |
| Volume | 37 |
| Issue number | 12 |
| DOIs | |
| State | Published - Sep 2022 |
Funding
Dr. Burstein’s support came from the Northwestern University Division of General Internal Medicine and Geriatrics Clinical Research Fellowship. Dr. Michelson has funding for unrelated work from the National Palliative Care Research Center and the National Institutes of Health. Dr. Linder is supported by a contract from the Agency for Healthcare Research and Quality (HHSP233201500020I) and grants from the National Institute on Aging (R33AG057383, R33AG057395, P30AG059988, R01AG069762), the Agency for Healthcare Research and Quality (R01HS026506, R01 HS028127), and the Peterson Center on Healthcare. Dr. Linzer is supported through Hennepin Healthcare for his work in burnout prevention by the American Medical Association (AMA), the American Board of Internal Medicine Foundation (ABIMF), the Optum Office of Provider Advancement (OPA), and the Institute for Healthcare Improvement (IHI). He is supported through Hennepin Healthcare by the American College of Physicians (ACP) for training wellness champions and assessing their impact on well-being and worklife in Internal Medicine. He is also supported by NIH for work in shared decision-making and Burden of Treatment studies, and by the Agency for Healthcare Research and Quality (AHRQ) as a Program Director for a K12 award in Learning Health Systems (LHS) training. He consults on a grant for Harvard University on work conditions and diagnostic accuracy.
Keywords
- burnout
- caring
- physician-patient relationships
- purpose
- wellness
ASJC Scopus subject areas
- Internal Medicine