Have you ever had a bad experience with a doctor? Maybe they rushed through the appointment, didn’t act like they cared, said something insensitive or rude? I have and there’s something so vulnerable about sitting in a little room, in a backless gown, maybe you’re nervous or scared, telling a stranger how bad you’re feeling and have them respond in an aloof or careless way.
“Communication was not taught even 20 years ago when I was in medical school,” said Seattle Group Health urgent care physician Nina Greenblatt. “More and more, residencies and medical schools are teaching it. But depending on people’s cultural backgrounds, their own extroversion/introversion, they are more or less comfortable communicating.”
Group Health wants to make sure all of its doctors have good bedside manner, so for the past nine years every doctor and nurse must take a class, taught by Nina, in patient communication. And part of the class includes practicing with trained actors and improvisors.
“Let’s say Randy is a new patient to you,” Nina gives a scenario to family practice physician Barbara Detering. “He is somebody who is already looking at his watch when you walk in the door. He is irritated that you’re running just 10 minutes late.”
An actor and improvisor, Randy Dixon is the artistic director of the Seattle improv company Unexpected Productions. He is given his scenario 30 seconds before the doctor walks into the room.
“Good afternoon, I’m Dr. Barbara Detering. Nice to meet you today. How are you?”
“I’m doing okay,” Randy said, visibly annoyed. “Now that you’re here.”
“Sorry to keep you waiting.”
The actors are assigned medical conditions and difficult personality types that a doctor might be struggling with.
“A while ago I played a character that was diagnosed with cancer and we had the difficult conversation,” said Randy. “This person was a singer. To treat the cancer they were going to have to give up their singing career and the doctor was basically put in a position where he had to give that news. So it ramped up pretty quickly. At what point does he stop being a clinician and has to be a fellow human being?”
Even though the doctor knows it’s just a scenario, and they’re being watched by trainers, sometimes they can’t hide their bad behavior. Dr. Greenblatt recalls a senior doctor who was a very skilled clinician.
“Who had very poor patient satisfaction scores. He was interested in moving up through the organization, but was getting information from his superiors that that was not an opportunity for him given that not only his patients, but some of his colleagues, were ruffled by his communications style, which was very dry, very flat, very one sided. He didn’t see emotional cues. He didn’t even notice them.”
So she started with some basic advice.
“Start with asking a patient, ‘Hey, I’ve never met you before. Tell me a little bit about you life.’ Totally out of his comfort zone. That is not what he went to medical school for.”
But the doctor took the constructive criticism, changed his ways and was promoted to head of his department.
Dr. Greenblatt said patients benefit greatly from strong connections with their doctors.
“Because of the way medicine is changing, so many of our clinicians are burnt out and have lost touch with why they started and feel that it’s just about getting through the visit. Our whole goal to have them not get through their day, but to enjoy their day. I know that if they’re happy, their patients are going to be happy.”
Randy said he’s been surprised by doctors’ behaviors during some of these scenarios.
“One of my oddest moments was this [doctor] who was talking to me, he never made eye contact with me once. When he would look at me, he would actually look above my head. It was very disconcerting, it was very strange, I felt invisible! All he needed to do was make eye contact.”
“What we focus on is that the clinician always has their heart in the room,” added Dr. Greenblatt. “That is what so many of our patients want from us. They just want to be seen and be witnessed in their struggle.”
Dr. Detering said new doctors and more experienced doctors can all benefit from the training.
“Even though we may believe that we are being patient and being kind and being empathetic, it’s possible we’re not. So it’s extremely helpful to have somebody watch us. We can spend years and years behind a closed door in an exam room with nobody seeing how we’re taking care of our patients. I think it is very valuable for that reason.”