Reflection about communication behaviors with patients: Evidence for reflective practice as a cornerstone for patient-centered care

Although ongoing research documents the relationship between physicians' communication behavior and better health outcomes, best practices for understanding and teaching communication continue to unfold. This investigation introduces reflective practice as a way for family medicine residents to pay attention to their own and their patients' verbal and nonverbal messages in healthcare interactions. Family medicine residents (N= 24) were provided time and required to complete three reflective exercises per week for one year. The exercises were intentionally left as opportunity for reflection without more specific goals for how the reflection would be used. We termed these reflective exercises “clinical blogs” since they were entered into a web-based computer portfolio, though they were not available to the general public. This study examines reflection about communication behaviors in family medicine residents' written reflections over the course of the full year. Through grounded-theory based qualitative analysis, the authors identify and describe themes in the ways family medicine residents write about their own and their patients' communication behavior. Identified themes include 1) recognizing the ways physician behavior influences subsequent patient behavior and disclosure, 2) learning to pay attention to the subtleties of patient behavior that provides a fuller picture of their life and their coping with illness, and 3) integrating images of growth and awareness as connected to reflection about communication. Identified themes provides evidence for the ways ongoing experience with reflection can aid physicians' awareness of the ways they respond to (or miss) subtle but important cues from patients.