The Hidden Power of Humility: Elevating Patient and Provider Experience Through Clinician Self-Awareness and Patient-Centered Care

Introduction

In June 1910, Dr William Mayo was the invited speaker for the Rush University Medical School graduation ceremony. ¹ His presentation included sage advice for the young graduates. At that point in his career, he was very accomplished and successful. He and his brother, Charles Mayo, led a group practice that had undergone tremendous growth over 20+ years. St. Mary's Hospital was one of the most prestigious hospitals in the country, with more surgeries than any hospital in the country. He had been the youngest president of the American Medical Association. Patients and physicians from all over the country and world were coming to seek care and share/learn in Rochester Minnesota.

The most famous of Dr Mayo's quotes arose from that commencement speech when he stated “the best needs of the patient are the only interests to be considered.” Later that year, Dr Mayo provided a similar presentation to the staff. It was received with tremendous enthusiasm; inspiring the codification of Mayo's primary value: “the needs of the patient come first.”

In a lesser-known quote from that same sentence, he adds “that in order that the sick may have the benefit of advancing knowledge, a union of forces is necessary.” The honesty of this statement reflects a necessary humility, in even the most successful among us. This humility is an essential virtue in providing the best possible care for our patients. A more prideful individual may have reminisced about “his” or “her” success and how he or she was able to overcome adversity to be in such a position. But Dr Mayo instructs the graduates rather, to focus on the patient and understand that one cannot do it alone. This profound wisdom remains an endearing legacy for all of us.

Actionable Insights

David Brooks states that “Humility is an awareness that there is a lot that you don’t know and a lot of what you think you know is distorted or wrong.” ² He goes on to state: “It is the awareness that your talents alone are inadequate to the tasks being assigned to you,” ² which aligns with our charge of keeping the needs of the patient first. Medicine and the human body are extremely complex and necessitate a multidisciplinary approach to care. Numerous studies have demonstrated that a multidisciplinary approach is essential in optimizing patient care, maximizing patient safety, decreasing length of hospital stays, and improving quality.^3–7

Humility is an honest assessment of our limitations and thinking less about oneself. This sentiment will enhance our ability to prioritize the needs of the patient first ahead of our own interests. Caring for patients is a privilege. Honoring of the privilege is essential in helping not just the patient but our entire profession. When we act in ways that do not express these sentiments, we are more vulnerable to fail in putting the needs of the patient first, limit our own professional growth, undermine patient trust, and effectively harm the entire medical profession.

Humility is not a virtue that many consider valuable or essential in our current culture and age of self-promotion. In fact, it is often mistakenly considered a sign of weakness and unworthy of the respect it deserves. However, Coulehan eloquently provides a view on humility, underscoring its power in our profession “Countercultural though it is, humility needs not suggest weakness or self-abnegation. Quite the contrary, humility requires toughness in emotional resilience. In medicine, humility manifests as 3 qualities: An unflinching self-awareness; empathetic openness to others; and a keen appreciation of, and gratitude for, the privilege of caring for sick persons.” ⁸ In an almost dare or challenge he goes on to say: “None of this is easy.”

Keeping our focus on the needs of the patient requires consideration beyond ourselves. And that desire will help us unleash all the resources and talents toward that goal. We become better listeners, ensuring that our history is thorough and accurate. The patient becomes part of the decision-making team. Providers are more likely to acknowledge their knowledge and expertise gaps and lean on others to help. Humility fuels that desire to do best for our patients.

Patient trust is built on actions that reflect patient-centered care. A humble physician will say “I don’t know” but follows up with “but I will do what I can to find out or send you to one of my colleagues who may know.” To some, saying “I don’t know” may be understandably viewed as failure or inadequacy and may negatively impact patient confidence. However, this honesty in prioritizing their needs demonstrates that we are doing everything possible for their benefit.

In addition, many are taught during training to never say “I am sorry” as it implies fault. However, when patients learn that we genuinely care about their well-being, apology is seen as comfort and a genuine reflection of empathy. While this action runs the risk of inviting criticism, it will engender trust and show respect for the patient. A humble physician does not fear this potentiality. In addition, the humble physician is more likely to grow from this patient-centered approach.

A growing amount of research shows clinician humility to be strongly associated with improved patient-clinician relationships. Hyuhn et al examined patient's perceptions of behaviors that characterize humble physicians. ⁹ They defined 5 characteristics: (1) friendliness and approachability; (2) nonverbal communication/mannerisms; (3) patient focus; (4) respect for patient; and (5) knowledge and admission of their own limitations. They then queried 326 patients and reviewed comments pertaining to each of these characteristics. The patient responses correlated well with characteristics of physician humility. Patients prefer humble physicians.

Physician humility is also l better patient outcomes and improved doctor-patient trust. One study queried patients who were seen by clinicians and correlated physician humility with the following variables: (1) satisfaction, (2) trust in their provider, and (3) health status. The study queries 497 patients from 2 separate groups: undergraduate students (136) and the community at large (361). ¹⁰ Patient satisfaction was measured using the Short Assessment of patient satisfaction and included questions such as “How satisfied are you with the care you received from your doctor?,” “How satisfied were you with the effect of your treatment?.” Trust was measured using interpersonal trust in patient-clinician scale and included questions such as “If my doctor tells me something is so, then it must be true”; “I sometimes distrust my doctor's opinion and would like a second one” (reverse coded). Patient health status was assessed using the Health Status Measure by UeroQuol Group to indicate their health status. The authors found that physician humility positively influenced patient satisfaction, trust, and self-reported health outcomes.

Humility applied to our colleagues is also enormously powerful and impactful. Humble leaders help create environments that promote engagement, inclusiveness, and psychological safety. This has been associated with improved patient safety and outcome. Practical examples of the power of humility are often best seen in stressful settings. Over 20 years ago, when I was early in practice, I recall with appreciation an experience that reinforces the power of psychological safety. I was performing a hip arthroplasty revision. It was a challenging case that also required fixation for a periprosthetic fracture. Following fracture fixation and implant placement, I asked for a new femoral head component (ball for the ball-socket joint). After a long surgery, I requested a 28-mm head to be opened to reduce the hip, assess stability, and begin closing the wound. There was a delay in the new femoral head being opened. I asked a second and then third time. I must have sounded stressed when I asked the third time and looked up to see the circulating nurse kindly reminded me that the patient had previously had a 32-mm head. I often reflect on that episode (and countless others throughout my career) with undying gratitude. Exhibiting humility and respecting team members nurtures that essential engagement and empowers individuals to help us better fulfill that mission of keeping the needs of the patient first.

Practical Recommendations

There are both systemic and internal (both from the provider and patient) barriers to patient-centered care. The process of seeing a physician is onerous and can be difficult for patients. Because many visits involve important and often serious concerns with their well-being and health, patients often feel vulnerable: physically, mentally, and often, emotionally. It can be difficult for patients to express themselves, navigate the complexities of modern healthcare systems, and fully understand what is said to them.

In addition, physicians often feel the pressure of having to know it all or be “confident” to engender the trust of their patients. They are often terribly busy and have demands on time that challenge our abilities to remain patient centered. The healthcare system can also be logistically challenging to navigate when ordered additional studies, placing referrals to colleagues or other specialists. It is not unusual to feel like they need to justify their decisions.

Today's culture of self-promotion and accomplishment also poses challenges to the notion of humility being an important virtue. Even in medicine, which is among the most noble professions, we are strife with prideful individuals who fail to consider the patient's needs above themselves.

Humility challenges us in many ways. It goes against our natural instincts of self-preservation and self-promotion. In addition, it seems more difficult to tap into humility early in our careers. Uncertainty and lack of experience in understanding our craft, patients’ needs and complications, can make it difficult to lead with humility in patient interactions and our collaborations with colleagues. A steadfast focus on the needs of our patients helps keep us on an even keel and is critical to our growth. One patient at a time, one day at a time, humility drives our passions for patient-centered care.

Summary

Humility is a tremendous strength in our quest for patient-centered care. Not only are patient outcomes better but humble caregiver behavior also engenders trust and results in higher overall patient satisfaction. Humility with our colleagues and staff also improves engagement, psychological safety, and institutional quality.

There is also a significant benefit to the providers. Humility is a critical ingredient in helping us achieve what Dr Paul Brand described as the nirvana-like experience (or true joy) of the provider-patient relationship that he named “the mutuality of medical care.” He states “When we share not only our knowledge and skill but part of ourselves with our patients, when we see something of our hope and faith awaken in them, then something comes back to us. It's in the mutuality of medical care that we experience real joy.” ¹²

We began this manuscript with a quote from Dr William Mayo and we would like to end it with a quote from Sir William Osler. In 1906, Dr Osler attended a dedication for the first medical school building at the University of Minnesota and stated: “In these days of aggressive self-assertion, when stress of competition so keen in the desire to make the most of oneself so universal, it may seem a little fashioned to preach the necessity of humility, but I insist for its own sake, and for the sake of what it brings, that a due humility should take the place of honor on the list. For its own sake, since with it comes not only a reverence for truth but also a proper estimation of the difficulties encountered in our search for it.” ¹³

We believe these 2 experienced physicians reflect genuinely powerful wisdom. Humility is an essential characteristic in helping us focus on patient needs, and our profession would do well to hold this virtue in high esteem.