Chapter

GC Khilnani, Suman Banerjee
IntrOductIOn
Medicine as a discipline has always faced a complex epistemological order and structure. Since the time of Hippocrates, where the first seeds of a rational discipline were planted, there has been an effort to reconcile its electively scientific nature with the “humanistic” dimension of caring for patients. This imposes a constant confrontation between the subjective experience of the “truth of the doctor” on one hand and the “truth of the patient” on the other. This is where the role of proper communication and appreciation for each other comes in.
With digitalization and artificial intelligence (AI), the life is becoming much more comfortable. No longer one has to stand in queues to deposit bills or go to bank to do essential jobs. Every job is done with a ‘Click’ on your mobile phone. The pandemic of CovId led to medical consultations being imparted on phone and video call. However, Medical care, where ‘zero error’ is the goal, and it is an art which is practiced with sound knowledge of science is entirely different which requires compassion, care, and empathy for suffering individuals. While some of the soft skills are common with all professions such as leadership and managerial qualities, there are special soft skills which are part of our profession. Unfortunately, medical curriculum does not include this part at any stage of training. This chapter discusses various aspects of soft skills which go a long way in providing best care to the patients.
For physicians, it is very important to possess hard skills as we are dealing with human beings and not a machine, therefore, knowledge and clinical skills should be optimum to impart care. This includes, knowledge of the diseases, clinical skills. capability to do analysis of clinical findings and lab data, good reading of
The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.”
—Sir William Osler—
1
1C.hPalpetaesre1notTehethSaotftwSkei’rlles ocfhtahneg2in1sgt CtheentuhreyaPdhinygsicSiaunm-Cmaradriyoltogist conclusion in order to maintain the consistency of the book.
1
Author Query: Recent Advances in Cardiology

radiology and interpretation of research studies. There are so many advances in the diagnosis and treatment of diseases and every day there is new information pouring in medical journals. It is important for all physicians to be updated with current knowledge of medical practice to impart optimum care. Besides making a living, the profession has greater responsibility of serving the society and assist in relieving pain, stress and prolonging life. This profession is unique and different from other occupations as you deal with human body and life cannot be replaced like machine or a car. Therefore, it is indeed a great opportunity for us to provide compassionate care and comfort with sound knowledge of medicine which is all about providing medical care to suffering patients. Besides, providing appropriate medical treatment it is important to empathize and communicates with a patient to allay anxiety and stress and instil hope. Quite often after a good consultation and communication patients’ comment ‘I am already feeling Better’ is a true attestation of soft skills. on the other hand a ‘crisp and ultra brief conversation with the same prescription would leave a patient dissatisfied and miserable after leaving doctor’s room.
Soft skills of a physician are essential part of the job as is some ones well-being and survival is threatened compounded with anxiety, uncertainty, depression and dismay. Patient comes to doctor because he is suffering and seeking relief. He looks at his physician to provide attention, care with compassion and wants his care provider to understand his woes. Patient should never get a feeling of being treated as a ‘client from a service provider’. Therefore, the art of medicine is a combination of knowledge of science and practice of medicine which requires, beside medical knowledge, helping, understanding and compassionate care foregoing other considerations of compensation or at times awkward behaviour of the patient due to his or her frustrations. It is natural that patients have a respect for the doctor and our conduct should sustain his feeling, else the care provided would be incomplete and unsatisfactory. It would not be incorrect to state that there should be ‘missionary zeal’ as part of our professional practice. That is the reason that this profession is called a ‘noble profession’.
Besides, that medical care is not the sole responsibility or the job of physician only, but a teamwork which includes nursing staff, pharmacist, paramedical staff and others which jointly deal with the patient care. Therefore, the soft skills of a physician also involve a leadership quality which should be more of collaboration rather than administration for taking every body along and also giving credit and appreciate work of younger colleagues and other staff with due respect. An encouraging attitude while following strict discipline for patient care is an art which we all must possess. Therefore, soft skills of a physician also must include leadership qualities.
With availability of investigations including blood tests, ultrasound, CT scans, MRI PET scans and angiography, there is tendency to rely entirely on investigation without having proper history and physical examination and communication with patient about his symptoms, and underlying anxiety and at times depression. In a busy oPd there is always shortage of time hence one is in a hurry to finish the consult by looking at investigations and writing a prescription based on ‘hard
2 Chapter 1The Soft Skills of the 21st Century Physician-Cardiologist

skills’ possessed by the physician which are very important. Physical examination is carried out to achieve diagnosis but it has another benefit as patient feels a comforting touch and care by his doctor he trusts.
The skill of a doctor in making a correct diagnosis or doing a skilled surgery can be assessed and measured accurately. However, it is important to understand value of soft skills of a physician for which there is no measurement and are very important for the ‘care of the patients’ at the same time., the quality of care and patient satisfaction is also determined by active listening, compassion, respect for the patient and empathy.1 These skills are based on ‘human touch’ to medical care and a feeling of empathy and the expression of the same. In the rapidly changing scenario of today’s world and the undeniable impact of the social media and data availability, it is very important to develop soft skills other than just the professional ability for all the stakeholders in healthcare. The development of soft skill and its significance has been an important topic of discussion, research, training and is now an integral part of human resource management. The deteriorating patient- doctor relationship, where there is a trust issue on either side can be handled with the development of soft skills. The components of soft skills are many and we would discuss the same.
cOmmunIcatIOn
The art of active listening, paying full attention, eye contact and nodding goes a long way in gaining confidence of patients as they know that you are intently trying to understand his problem with interest. Some of the symptoms are often not explained by a known disease or a syndrome. one should never ridicule the same and dump it as being psychogenic. More often it is our inability to find a cause for the same. Avoid using medical jargons during communication and pass on the relevant information and keep the channel of communication open. The advancements in the field of cardiology and other specialties have led to the development of complex and highly technical procedures, which need to be explained as clearly as possible including financial implications. It is equally important to involve family members in the conversation as very often the decision making is done jointly with them
InterperSOnal SkIllS (empathy and cOmpaSSIOn)
Empathy: It is the center of any human relationship and the same is true for doctor and patients. Empathy is essentially the ability to put yourself in other’s shoes and see the problem or a situation. The common dictum: ‘Behave with a person as you would like to be behaved’ is so true while dealing with a suffering person. Radiating that feeling develops trust which is so important in the management of all patients. Empathy has three major levels:

1. Cognitive empathy: It is the ability to understand how patients see things and what they may be thinking or struggling with.
2. Emotional empathy: It is the ability to move from understanding to feeling their emotions.
   3 Recent Advances in Cardiology
3. Compassionate empathy: It is action oriented as the person not only understands, and feels, but he or she is willing to help and ready to act.
   Being warm, compassionate and sincere, immediately creates a conducive
   atmosphere in patient management and in trust building which is so important in patient-doctor relationship
   teamWOrk and cOllabOratIOn
   Joining the efforts from different professionals (specialists) improves patient management in contrast with the old idea of a global treatment offered by a single physician. Global changes in healthcare necessitated new strategies and ways of working. Currently, there is widespread international recognition that bridging the boundaries of professional disciplines is required to address the challenges posed by changes in healthcare, validating the World Health organization’s call to meet the complex service as need of the future through interprofessional collaboration.1 It has been well documented and studied that shared leadership is an effective way of delivering efficient care.2 The leadership role is not necessarily restricted to those who are designated in that role. By encouraging participation in decision making and sharing responsibility and showing trust one can build up a robust team. Breaking down barriers leads to efficient team development. It is very important that due respect and consideration be given to every member who is contributing to the care make him an integral part of the team.
   emOtIOnal IntellIgence
   Social–emotional skills have been linked to success across a wide range of positions and roles in the field of medicine. It has been linked to effective performance under pressure, increased commitment to healthcare organizations, positive interpersonal communications, and effective teamwork among medical staff. Studies have pointed out correlations between emotional Intelligence and better doctor–patient relations and fewer medical lawsuits.3,4 Empathic treatment, precision in medical diagnoses and consequently in treatment, lowers levels of situation-related anxiety in patients, and higher patient trust in healthcare staff.
   crItIcal thInkIng and prOblem-SOlvIng
   Critical thinking, is the ability to be deliberate about thinking and actively assess and regulate one’s cognition. It is an essential skill for all physicians. diagnostic errors are the number one cause of medical malpractice claims and are thought to account for approximately 10% of in-hospital deaths. A recent report from the Risk Management Foundation, the research arm of the malpractice insurer for the Harvard Medical School hospitals, labelled more than half of the malpractice cases they as “assessment failures,” which included “narrow diagnostic focus, failure to establish a differential diagnosis, and reliance on a chronic condition of previous diagnosis.”5 The ability to think ‘out of the box’ and assimilate and
   4 Chapter 1The Soft Skills of the 21st Century Physician-Cardiologist derive a solution using all the tools and information is an asset. As a cardiologist, one will keep facing such tricky and complicated clinical scenarios and this is where innovation and critical thinking will clinch the deal.
   adaptabIlIty and FlexIbIlIty
   Hospitals and health systems that undertake the work to become more flexible, adaptable achieve following benefits6
   ™ Faster speed-to-care
   ™ operational efficiencies
   ™ New opportunities for virtual care
   ™ Workforce stabilization
   ™ Improved patient outcome and satisfaction
   The common challenges that one faces for flexibility are: ™ determining where to begin
   ™ Managing the culture change
   ™ Implementing the technology infrastructure
   ™ Leveraging data to drive meaningful change ™ Protecting the investments
   cOntInuOuS learnIng and prOFeSSIOnal develOpment
   In the ever-changing world of medicine and with so much data available at the click of a button, it is but imperative, to stay updated with the latest developments and advancements. It is very important to not stagnate and for this, various Continuous Professional development modules are available. It is an invaluable framework that enables professionals to focus on structured, short-term quality improvements, which in turn will positively impact their long-term goals. It allows you to identify what you do well and what may require improvement, encouraging you to explore new knowledge, skills, and behaviours. overall, you become a more competent, efficient, adaptable, and confident professional.
   patIent-centered care
   In the last two decades, the patient‐centered care approach gradually replaced the medical paternalism that has dominated healthcare for decades. The patient‐ centered care model involves integrating patients› needs and preferences into the delivery of care, ‘moving away from a logic of “care to patients” towards one of “care for patients”’. Patient‐centered care is based on a patient‐oriented perspective of care that includes what patients consider important for their life project. Patient engagement in care has become a priority and a key component of clinical practice in many countries around the world. Engaging patients can help shape their care and treatment in ways that fits their requirements, ultimately resulting in improved outcomes.
   5 Recent Advances in Cardiology cultural cOmpetence
   Cultural competence is the ability to collaborate effectively with individuals from different cultures and such competence improves healthcare experiences and outcomes. Efforts to improve cultural competence and ethnic diversity will help alleviate healthcare disparities and improve healthcare outcomes in these patient populations. Healthcare today has persistent challenges with cultural competency, and racial, gender, and ethnic disparities. It is determined by many factors outside the traditional healthcare setting. These social determinants of health include, but are not limited to, education, housing quality, nutrition and access to primary healthcare. There is underrepresentation of cultural, gender, and ethnic diversity during training and in leadership. To serve the needs of a diverse population, it is imperative that the healthcare system take measures to improve cultural competence, as well as racial and ethnic diversity.
   dIgItal lIteracy
   digital literacy is described as “the ability to use information and communication technologies to find, evaluate, create, and communicate information, requiring both cognitive and technical skills”.7 Electronic Health Records (EHRs) have revolutionized healthcare delivery, offering numerous benefits for patient care and outcomes. EHRs have significantly improved patient care by increasing accessibility and accuracy of patient information. Healthcare providers can easily access patient records, including medical history, medications, and lab results, leading to more informed decision-making, reduction in errors and improved coordination of care. EHRs have been shown to improve patient care by supporting evidence-based practices and clinical decision-making. EHRs can provide alerts and reminders for preventive care and screenings, helping healthcare providers adhere to best practices and guidelines. Additionally, EHRs enable real-time monitoring of patient data, allowing for early detection of potential health issues and timely interventions. Therefore, adapting to the digital advancements and using technology adequately and also undergoing training for the same is crucial in today’s world. Artificial intelligence is already becoming an integral part of patient care and should be integrated in practice.
   leaderShIp and management
   Effective leadership is integral to quality of care. If a healthcare team is uncoordinated or unfocused, patients often pay the price. Great leaders facilitate communication, boost productivity, and put others first. The American Psychological Association identified seven crucial leadership qualities necessary for combatting the pandemic. These include:
   ™ Effective stress management
   ™ Empathy and optimism when sharing information ™ Building trust with expertise and dependability
   ™ Honesty and transparency
   6 Chapter 1The Soft Skills of the 21st Century Physician-Cardiologist ™ Consistent communication ™ openness to feedback
   ™ Ability to serve as role model
   cOncluSIOn
   As physicians of the 21st century it is but imperative that stress is given on acquiring the soft skills to navigate through the ever changing and complex social milieu. In medicine today, complaints rarely concern an incorrect or the lack of professional skills. Instead, it is increasingly focused on the lack of communication. The emotional barrier and their perception of the doctor as a ‘distant figure’ who is often unwilling to create an emotionally satisfying dialogue is a hinderance to patient satisfaction and optimum care. Besides, soft skills also serve as a tool in the hands of doctors to reduce legal disputes and accusations of incompetence, imprudence or malpractice. The medical service involves suffering human beings who is looking for compassion care with empathy on the part of health care providers of which physicians is most important. It is our duty to acquire these skills to be an ‘ideal physician’.
   reFerenceS
4. World Health Organization. Framework for action on interprofessional education and collaborative practice. World Health Organization; 2010. Available from: https://www. who.int/publications/i/item/framework-for-action-on-interprofessional-education- collaborative-practice.
5. Warren OJ, Carnall R. Medical leadership: why it’s important, what is required, and how we develop it. Postgrad Med J. 2011;87(1):27-32.
6. McCallin A, Bamford A. Interdisciplinary teamwork: is the influence of emotional intelligence fully appreciated? J Nurs Manag. 2007;15(4):386-391.
7. Global minimum requirements of Medical Education. Available from: http://www.iime. org/documents/gmer.htm.
8. Hoffman J, editor. 2014 Annual benchmarking report: malpractice risks in the diagnostic process. Cambridge, MA: CRICO Strategies; 2014. Available from: https://psnet.ahrq.gov/ resources/resource/28612/2014-annual-benchmarking-report-malpractice-risks-in-the- diagnostic-process.
9. Igoe K. Change Management: Why It ́s Important, and So Challenging, in health Care Environments. Harvard TH Chan. 2021. Available from: https://www.hsph.harvard.edu/ ecpe/change-management-why-its-so-important-and-so-challenging-in-health-care- environments/.
10. American Library Association. 2017; UNESCO (United Nations Educational Scientific and Cultural Organization). 2011.
    7