In today’s hectic world, human relationships are increasingly mediated by electronic technology. Powerful computers and data networks power the ubiquitous Internet. Mobile communications and social media platforms have transformed how individuals relate to other people, institutions, and the world at large. In the medical realm, the Affordable Care Act and the 2009 HITECH Act mandated the use of electronic health records (EHR) and, in doing so, catalyzed its widespread adoption by physicians and hospital systems.
How have these seismic shifts in interpersonal communication and clinical documentation affected the physician-patient interaction? Can an understanding of the biblical phrase panim el panim inform these interactions in a way that deepens the physician-patient relationship and, ultimately, improves patient care?
Panim el panim in straightforward translation means “face-to-face.” As a family physician, I know that most clinical interactions are face-to-face. In the bygone days of paper charts, my attention was naturally directed, nearly entirely (aside from jotting a few paper notes), toward my patient. There was no ever-present technology to be utilized while attending to the patient before me. Today, my floating flat screen sits 45 degrees to my right, intervening in the physical and interactive space between us and invariably siphoning off a portion of both my cognitive and my physical attention from the patient. I have always endeavored to focus on my patients, listening closely to their words, monitoring mood, affect, facial expressions, verbal tone, and body language. The distraction of concurrent EHR navigation stresses the quality of human interactions integral to the physician-patient relationship. From my personal observations as well as published studies, it is clear that physicians using EHRs (which we are compelled to do) focus significantly less on patient-centered communication. Although it is undoubtedly true that EHRs have improved clinical documentation, it is also sadly apparent that they have diminished the art of clinical medicine.
This art is practiced when forging com-passionate connections with patients, as we try to fully understand their concerns as well as how their health problems affect their lives. Assessing a patient’s wellness or illness is a process facilitated not only by physically seeing but also by attentive listening and recognition of nonverbal cues.
The phrasepanim el panim is encountered first in the book of Genesis, after Jacob wrestles with a man-angel who thereafter changes Jacob’s name to Israel. Recognizing the man-angel as God, Jacob declares, “for I have seen God face-to-face, and my life is preserved.” (32:31) During this profound struggle with God, both God and Jacob were wholly present. Engaged in a relationship with the other, they were able to fully “see” each other. Jacob becomes a survivor, now bearing a new name that transforms his and his descendants’ destiny. God too is changed, as God now recognizes a true covenant-partner, one who will question and challenge.
Similarly, by fully engaging with and “seeing” the whole patient, physicians are better able to understand a patient’s illness and its meaning, and, ultimately, we can help transform illness into wellness. This is at the core of the art of medicine.
Physicians need to prioritize human connections with their patients in order to fully understand the nature and import of their illnesses. Only in this way can we provide the best clinical care our patients deserve. We must increasingly turn the monitor aside (if even for just a few minutes) and, with humility and wisdom, feel empowered to be truly present — to observe, listen to, sometimes struggle with, and ultimately be face-to-face with our patients. Panim el panim, in its deeper sense, is a model by which we can help transform our patients’ lives, in ways both large and small. Along the way, we too might find ourselves transformed, small measure by small measure.
Dr. David Chodirker , is the founding partner at Wellesley Family Care Associates. Married with four children, he lives in Newton, Mass.