Synopsis: Doctors too often use language that’s indeceipherable to normal people. Efforts are underway at medical schools to teach doctors to speak in plain language. An expert at one such school and a participant in these classes discuss.
Host: Nancy Benson. Guests: Dr. Evonne Kaplan-Liss, Assoc. Prof. of Preventive Medicine, Stony Brook Univ.; Ashwin Mahotra, medical student, Stony Brook Univ.; Dr. Zack Berger, Asst. Prof. of Medicine, Johns Hopkins Univ. and author, Talking to Your Doctor: A Patient’s Guide to Communication in the Exam Room
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Training Doctors How To Communicate
Nancy Benson: If your doctor told you you needed an end-to-end anastomosis you‘d probably shake your head and say, “huh?” Unfortunately, it happens all the time. Doctors and scientists have a bad habit of using jargon we normal people can’t understand, even though it’s not good for patients or for getting funding for scientific research. Actor Alan Alda had to say some of those indecipherable terms back in the 1970’s and early 80’s when he played an army surgeon on the hit tv series Mash… And almost ever since, he’s been on a mission to get doctors and scientists to speak in terms we can all understand, without leaving accuracy behind. He’s finally found a partner in the Stony Brook University Center for Communicating Science.
Evonne Kaplan-Liss: It’s the first of its kind with the mission of teaching scientists and healthcare professionals to be more effective communicators with the public, with their patients, with the media. And we do this through teaching them improvisation and other tools, how to affectively communicate by distilling their message and we also teach them how to use digital media and other tools to get their message out to the public.
Nancy Benson: That’s Dr. Evonne Kaplan-Liss, Associate Professor of Preventive Medicine at Stony Brook University, and Director of the Advanced Graduate Certificate in Health Communications. Part of the program is an elective six-week course where med students participate in improvisation workshops, some led by Alan Alda himself.
Evonne Kaplan-Liss: Physicians are trained to be empathetic and to communicate with their patients with language but they’re not often trained to understand their patients through body language.
Ashwin Mahotra: Truth be told, the first improv experience I was really nervous and I was kinda hesitant and I didn’t think it was important. I was like “Why are we doing this? This is a waste of time, we should be sitting down reading scientific papers and figuring out how to translate them to normal people.”
Nancy Benson: That’s Ashwin Malhotra, who as a first year medical student at Stony Brook University School of Medicine, participated in the Alan Alda improv workshop.
Ashwin Mahotra: But then as the session progressed, within like thirty, forty-five minutes I felt the power of improv. I was like “Oh wow!’ You know I’m not enjoying it because I’m struggling because I’m not a good communicator. I’m having a very hard time expressing what I want to say with my body language. I’m having a very hard time trying to guess what this person is trying to say, and I’m having a very hard time just like following directions without like having it rehearsed or pre-scripted.
Nancy Benson: Malhotra says improvisation workshops are a lot different than the traditional clinical simulations offered by most medical schools, where trained actors play the part of patients in a very scripted role.
Ashwin Mahotra: When we asked them a question like “What brings you in today? How are you feeling? Where does it hurt?” They know exactly what to say, they know exactly the one word answer, two word answer that they’re programmed to say. If they ever don’t understand something that we’re explaining to them, we just kind of move on. But in these improv sessions you’re with another person, it’s live– there’s no script. And I was playing doctor. Another student was playing a patient, and we just sat down and had a conversation. And in the medical school simulations we’re more focused on asking the right questions in the right order to get a history or do the physical exam. In these improv sessions, when Communicating Science it was different. We weren’t focused on asking the right questions or the right order. We were more focused on the tone in which we were asking the question.
Nancy Benson: And, unlike what occurs in most clinical simulations, people who are role-playing the patient during improvisations are free to ask the doctor questions.
Ashwin Mahotra: Lets say someone comes in with abdominal pain and you start asking them how are they sleeping? And the serious patient is just gonna answer you, but in Communicating Science, the role questions are like: why are you asking me about my sleeping patterns when I have a pain in my stomach? It’s disconnected. So just explaining that because as a physician, or as a future physician, we’re trained to connect the two, and we’re trained to just ask pertinent positive, pertinent negative questions till you kind of figure out what’s going on with them, but the patients might not understand why we’re asking such esoteric questions or disconnected questions.
Nancy Benson: In his first improvisation experience, Malhotra had to play physician to a young female patient with heartburn. Kaplan-Liss watched the exchange.
Evonne Kaplan-Liss: When he walked into the room, he went right to wash his hands because that’s what they teach you in medical school. Always wash your hands. It’s very funny. Medical schools are very rote, you know what I mean, they’re told to do something and they do it. So he’s told to always wash your hands, but he walked into the room and in a fake setting washed his hands, but didn’t even eyeball the patient when he walked in the room. So we picked up on that through the improv it was interesting.
Ashwin Mahotra: One of the critiques that I got was I seemed distant as a physician. The way I was sitting, I was sitting a little further back, I was very rigid and seemed a little intimidating to the patient. I could have been a little more comforting, sat a little closer, and I seemed very to the point just wanted to move on to the next question trying to figure out what’s going on with her what’s wrong with her condition. I didn’t spend enough time on her occupation or how’s her social life or the other questions that are very important in a medical history.
Nancy Benson: Okay, fixing those problems might help a doctor connect with a patient. But physicians don’t have all day to spend with us in the exam room. So, isn’t this approach a little impractical?
Ashwin Mahotra: I would say this improv session absolutely helps you in a way to establish that rapport, that level of trust in a quicker fashion actually. What this improv session really taught me is that you’re gonna learn to introduce yourself, just go and shake their hand tell them that “Hey, If its okay with you I’m gonna go wash my hands first.” And then really get started and then typically when we open an interview it takes thirty seconds not even ten seconds to say to the patient “Hey listen before we begin this interview or this physical exam that I just want to let you know that everything we talk about is confidential. Please feel comfortable to discuss anything with me and please interrupt me if you have any questions.” Just those like two sentences establishes a very powerful relationship with the patient from the get-go. The biggest challenge of history taking is the patients are withholding information. They feel uncomfortable discussing certain things. Or certain things are just not something that they talk about, like no one wants to discuss diarrhea. But it’s a very important part of the medical history, so if you have a good relationship, they feel comfortable with you, it’ll make the rest of the history taking very easy.
Nancy Benson: But according to some doctors who’ve been in practice for years, not all patients are mystified by medical jargon. Some patients actually prefer it.
Zack Berger: Some people can be very familiar with medical lingo if they’re unfortunately sick or have been sick for a while. They have family members who are sick, so people can learn the language. So, that’s one way of doing it. Patients sometimes feel familiar with the language, and they want doctors to use that language because they don’t want to feel like they’re being talked down to.
Nancy Benson: That’s Dr. Zack Berger, Assistant Professor of Medicine at Johns Hopkins University and author of the book Talking To Your Doctor – A Patient’s Guide To Communication In The Exam Room And Beyond.
Zack Berger: In some cases, there are probably people that a certain obscurity or a certain remove makes them more comfortable. It makes them feel like the doctor knows what they’re talking about. So, I think that that’s definitely the case, and you know it’s not just explaining things in simple language. It’s figuring out what the patient knows walking into the room ,what they’re hoping to hear, what they’re expectations are, what their needs are and then communicating in that direction. The way a doctor helps a patient understand something should really depend on where the patient is coming from– the context in which the person is coming from.
Nancy Benson: Today, doctors need to straddle two worlds. We expect them to be knowledgeable about what’s wrong with us, but we want them to be comforting and people -oriented, too. It’s a tall order – but Alan Alda believes it’s well within reach. With attention and practice, even the geeky medical nerd can become a better listener, a better communicator, and a better doctor. Our writer this week is Polly Hansen our production director is Sean Waldron. I’m Nancy Benson.