Title: The Expense of Presence in Health Care: An Important Insight on Listening

In a world increasingly filled with distractions and rapid digital advancements, one significant yet often overlooked challenge in medical education and health care delivery is the ability to foster genuine presence. Presence—an authentic, undistracted engagement with individuals—is not simply a soft skill or an optional attribute; it is progressively acknowledged as a core competency vital for effective, compassionate, and ethical medical practice. Kathleen Muldoon, a certified coach, anthropologist, and medical school faculty member, eloquently discusses this notion in her KevinMD article and podcast episode titled “The Expense of Presence: An Insight on Listening.”

Muldoon’s distinctive viewpoint, influenced by her dual roles as both an educator and a mother of a child with complex medical needs, provides a deeply personal and professional perspective on the importance of being entirely present in health care environments. Through her reflections and real-life experiences, she underscores a rising concern: that, in our quest for technical proficiency and knowledge acquisition in medicine, we might be overlooking the fundamental human values of empathy, compassion, and connection.

The Event That Triggered Contemplation

In the podcast, Muldoon shares a defining moment that motivated her article. During a presentation by a parent-caregiver of children with disabilities to a cohort of interprofessional medical students, one student was noticeably disengaged—scrolling through slides and seeming inattentive. For Muldoon, who recognized the emotional and logistical effort this parent had invested to share her personal story, the student’s inattention highlighted a more significant issue within medical education: a failure to teach and reinforce the art of presence.

She understood not only the potential detriment to the speaker—who had bravely volunteered to act as a community educator—but also to the student’s evolving professional identity. Disinterest in such an intimate moment could signify lost chances to internalize compassion and cultivate the emotional intelligence necessary for high-quality patient care.

The Unspoken Curriculum and the Exemplification of Presence

In medical education, the “unspoken curriculum” pertains to the implicit or unvoiced lessons not formally integrated into the academic syllabus but nonetheless absorbed by students through observation and experience. Muldoon contends that how educators exemplify behaviors—such as being present, listening intently, and nurturing human connections—could have an even more substantial long-term effect than formal training in anatomy or pharmacology.

She has advocated this idea through the “Humanity in Medicine” curriculum she helped create—focused on teaching medical students about courageous conversations and emotional self-awareness. This initiative encompasses storytelling, improvisational theater, and reflection exercises aimed at assisting students in remaining curious, empathetic, and open, even when confronted with emotionally intricate or politically sensitive situations.

The Significance of Empathy in the Clinical Interaction

Muldoon emphasizes that physicians are not required to possess all the answers, particularly in intricate or chronic circumstances. What is most crucial to patients and their families is that clinicians appear authentically engaged and willing to listen—to understand their narrative, validate their experiences, and accompany them in uncertainty.

This type of emotional partnership cultivates trust and enhances the therapeutic alliance. For parents of children with complex medical needs, for instance, feeling acknowledged can profoundly affect adherence to treatment plans and overall satisfaction with care. Patients and their advocates can sense when a physician is genuinely present—and that presence frequently holds more importance than a diagnosis or treatment strategy.

Presence as an Acquirable, Trainable Ability

A vital takeaway from Muldoon’s message is that presence is not an inherent talent exclusive to a lucky few—it is an acquirable, trainable ability. Like any other skill in medicine, it demands intention, practice, and feedback. In fact, honing presence can mitigate some of the burnout and emotional detachment that afflict health care professionals by keeping them connected to the reason they entered the field: human relationships and healing.

To this end, Muldoon encourages health care institutions to integrate presence-enhancing practices into curricula from the very beginning of clinical training. Reflective writing, facilitated group discussions, and storytelling activities serve to aid both students and clinicians in developing the “empathy muscle.”

Challenges to Presence: Digital Interruptions and Pressures

One of the main obstacles to presence in health care today is distraction—from electronic health records (EHRs), medical applications, email overload, and the psychological strain of multitasking. Students frequently balance overwhelming academic workloads, high-stakes examinations, and pressure to perform clinically. These factors can foster a mentality that prioritizes checking boxes over deeply listening.

Muldoon warns that these systemic pressures, if not addressed, threaten both patient care and physician well-being. She advocates for deliberate habits—such as stepping away from devices during patient interactions, embracing silence, and tuning into the emotions of others—to help clinicians reclaim their presence amidst the digital clamor.

Medical Student Resistance: A Case Study in Transformation

Muldoon narrates a success story of a medical student who initially resisted the course on courageous conversations, viewing it as secondary to “true” medical