Does Anyone Have a Case? The Balint Group Experience | to pdf >>
By Cecilia Runkle, PhD; Laura Morgan, MD; Eric Lipsitt, MD

So begins another Balint group for clinicians. Using a case presentation model in a facilitated discussion format, clinicians are invited to explore the clinician-patient dynamic. The deceptively simple process can enable clinicians not only to learn more about the perspectives of the patient but also to foster greater satisfaction in the practice of medicine. This is one possible method of practice-based learning that we are exploring to reinvigorate our vocation.

Since the 1950s, Balint groups have been used in medical schools, residency programs, and among practicing clinicians worldwide. Recent articles document the value of these groups in preparing clinicians for practice as well as provoking insight, personal growth and satisfaction among those clinicians who have been practicing medicine for some time.^1-3 According to the American Balint Society Mission Statement, the goal of the Balint Group experience is "for the participants to transform uncertainty, confusion and difficulty in the doctor-patient relationship into understanding and meaning that nurtures a more therapeutic alliance between clinician and patient."⁴

For over two years now, the Department of Medicine at Kaiser Permanente (KP) Oakland has sponsored a hybrid Balint/Practice Inquiry group for physicians, which combines evidence-based medicine with the traditional Balint approach. Every two weeks, a drop-in discussion is held, with lunches and meeting space provided by the department. Recently, Eric Lipsitt, MD, and Laura Morgan, MD, from the KP Oakland Medicine Department, with Cecilia Runkle, PhD, from Regional Physician Education and Development and Lucia Sommers, DrPH, author of the Practice Inquiry method, attended a Balint Leaders Intensive course in Portland, Oregon.

The Intensive

Over a four-day period, we participated in seven Balint groups, with opportunities to co-lead. Each session was followed by a one-hour debriefing of the group's interaction: what was observed in the leaders' and group's behavior? Did facilitators provide a safe environment for presentation and discussion? What could leaders have done to improve the way in which the group addressed both the clinician's and patient's perspectives? What occurred unexpectedly and how was it handled? One session was videotaped. Later in the day, the group observed and commented on facilitators' interventions.

The Value

The practice of medicine is often referred to as the "art of medicine." Our experiences in participating in and co-facilitating Balint groups reflect this adage. After a case is presented and clarifying questions answered, the presenter listens while the group verbally shines a light on the case from many perspectives. Gradually, the picture becomes three-dimensional, with many shades and possible meanings. The presenter is then invited back into the group discussion, free to view the picture of their case from new directions. Sometimes, a presenter will put further touches on the picture; sometimes one will paint it over completely; sometimes one will simply contemplate a new picture they'd not been aware of before. In all cases, for all participants, there is a change in perception that leads to finer practice of the art of medicine.

In the community of shared experience, with sensitive and strong facilitation, we learn to support and trust each other. Cases with "risky" content, such as doubt about our medical knowledge, difficulty setting limits, or negative feelings toward patients, become normalized and safe to share and thus better understood. In this community, we heal ourselves while we practice the art of healing others. We believe that Balint groups provide a forum for the kind of professional development that leads to spontaneous personalization of care. We hope to share our enthusiasm and support for initiating this process with all interested colleagues.

If you're interested in starting a Balint group, please contact Laura Morgan at laura.morgan@kp.org.

References

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