Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

The Reflexive Practitioner


Our own biases and judgements inevitably affect our care of patients. Deep introspection can help us overcome our prejudices and improve clinical practice. 

Sitting in the corner of a dimly lit exam room, I overheard the doctor say 33 patients were expected that morning. 33 in three hours. 11 an hour. About five minutes per consultation. Their average day, apparently. I silently watched on as an endless stream of patients came and went. Many of their questions were left unanswered and many concerns automatically dismissed. The clinicians were just too short on time.  


Until one patient came in. The doctor and patient struck up a conversation about where the patient was from, what brought them to Hong Kong, and what problems he needed help with. I wondered why this patient was treated differently. Then it hit me. It was about race.  


Reflexivity in qualitative research   

This example illustrates the need for reflexivity. Reflexivity isn’t as common a term as reflection, which seems to have found its way into every medical curriculum and training pathway. Reflection mainly addresses the who, what, when, and where, while reflexivity is an introspective deep dive into the why and how.   


I first learned about reflexivity in the context of qualitative research. Qualitative researchers must be reflexive, which means critically and repeatedly examining their own beliefs, judgements, and practices. These in turn are influenced by many different factors, like education and religion. If you have more experience with quantitative research, it may come as a shock to learn that qualitative papers increasingly include sections for reflexivity. The process aims to make the researchers’ influence on their work as transparent as possible.  


Reflexivity in medicine   

Even though our field is largely governed by guidelines and research studies, beliefs and judgements inevitably affect our clinical practice: in the way we talk, our body language, and the way we approach controversy and the unknown. Healthcare has never been and never will be free of bias, so why should we pretend? What we can and should do is be reflexive about it. Reflexivity is a process that takes time and effort. And it may be uncomfortable and unsettling. But the insight we gain and the positive change we can create makes it worthwhile.  


Here are a few things I’ve found helpful:


1. Engage in reflexive practice regularly.  

2. Jot down your findings. Review them periodically.  

3. Practice your newfound insights.  





This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.