Starting each visit with a centering exercise focused on the patient may allow one to be fully present.
My first piece on cognitive psychology and patient-clinician connections for CLOSLER is about my love affair with behavioral economics and positive psychology. Certain concepts really resonate with me, and deliberate practice is one of them. Here are a few key things to know about deliberate practice that may help you improve your connections with patients.
Dr. Anders Ericsson has a wonderful book that delineates deliberate practice, with salient examples from chess, sports, and music. Malcolm Gladwell popularized the idea of deliberate practice in his book, “Outliers,” with the oft-quoted “10,000-hour rule,” which he says has been misinterpreted. He didn’t mean to suggest that 10,000 hours of practice always equals expertise. There’s no exact number that can quantify or measure complete mastery, and there’s individual variation. That being said, in general, it takes about four hours of deliberate practice over 10 years (roughly 10,000 hours) before there’s even the chance for expertise.
The 10,000-hour rule and clinicians
I want to be an expert clinician and I’ve practiced more than 10,000 hours. But that time alone doesn’t necessarily make me an expert—imagine if I’d been continuously practicing all the wrong things!
For residents, an 80-hour workweek translates to reaching 10,000 hours by 2.6 years of clinical practice. Of course, no one is an expert clinician after only 2.6 years.
It’s not just time, and it’s not just 10,000 hours. Time needs to be dedicated specifically to each chess move that needs to be learned, each movement that can be perfected, and each musical technique not yet mastered. Here are the 3 steps of deliberate practice:
The deliberate practice activity should be of short duration.
There needs to be opportunity for immediate feedback, reflection, and correction.
Using the feedback that you’ve reflected on, focus on what needs to be corrected.
Deliberate practice is linked to having a growth mindset
I’m an introvert, and the myopia of being in my own head sometimes results in inadvertently being overly direct, brusque, and/or rude with patients. I never want to be perceived that way, and yet it isn’t easy to stay present outside of my head, focused on the person in front of me, while also navigating the complexity of an encounter with the medical record, exam, and data. Deliberately practicing—focusing on the person—has helped me. “Focusing on the person” is so broad; it’s not an activity of short duration. Noticing the color and details of their COVID facemask is a behavior that takes less than a second, and this action does help me to focus on the patient. Plus, there is immediate feedback and opportunity for reflection and correction—any time during the visit or after it is over, I can ask myself, “What was the patient’s mask like? Do I know? Did I see the patient in front of me?”
Simple, short activities are best for deliberate practice. Let us know what has worked for you!
For more info on this topic, check out my book, “How to Improve Patient-Clinician Connections.”
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.