Lessons from Master Clinicians: Listen to Your Patients

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Many, if not all, rheumatologists seek to grow as clinicians so they can provide consistently exceptional care to patients and serve as role models for colleagues and trainees. In The Rheumatologist’s Lessons from Master Clinicians series, we present insights from clinicians who have achieved distinction in the field of rheumatology and who are respected by other rheumatologists for their exceptional clinical reasoning, knowledge across a wide range of medical specialties and patient-centered care.

Beth Jonas, MD, FACR, is the Reeves Foundation Distinguished Professor of Medicine and chief of the Division of Rheumatology, Allergy and Immunology at the University of North Carolina at Chapel Hill School of Medicine. Dr. Jonas is a nationally recognized clinician educator and has been instrumental in establishing one of the country’s top-tier rheumatology fellowship training programs. In recognition of her leadership and vision, Dr. Jonas was given the ACR Distinguished Fellowship Program Director Award in 2015. Her work in developing a novel curriculum in rheumatology is supported by a Rheumatology Research Foundation Clinician Scholar Educator Award. Dr. Jonas also chairs the ACR’s Committee on Rheumatology Training and Workforce Issues.

TR: In your opinion, what makes for a master clinician?

Dr. Jonas: A master clinician must be a natural problem solver, someone who is skilled at and greatly enjoys figuring out mysteries. He or she must be comfortable with uncertainty and be able to look at each situation with an open mind so as to be able to consider all perspectives and possibilities.

As many rheumatologists know from clinical experience, the puzzle does not always come together perfectly. [Because] the practice of rheumatology is rarely straightforward, the master clinician must be thoughtful and creative when approaching a diagnostic quandary. There must also be a dedication to caring for each patient as a person, in a holistic fashion.

‘We must not assume that we know the patient’s goals & expectations. … It is … important to understand what patients want out of their treatment.’ —Dr. Jonas

At the same time, there should be a commitment to teaching patients and trainees alike. Many elements of rheumatology are complicated and do not make natural sense to patients. Thus, it is our duty as clinicians to explain our clinical reasoning to patients and answer all of their questions.

Over the course of a career, physicians continually acquire new knowledge, but it is the master clinician who is able to translate this knowledge into action, such as through counseling patients, teaching fellows and other learners, and using new evidence and knowledge to inform diagnosis and treatment. The master clinician is flexible and self-critical in the approach to care, is cognizant of his or her own strengths and weaknesses, and is willing to say, ‘I have not seen this before.’ It is through such humility and eagerness to learn from patients and students that the master clinician can grow and evolve.

TR: What are some habits a fellow in training or junior rheumatologist can incorporate into daily practice to build on their skills as a clinician?