Greg Hood, MD, Internal Medicine, 04:02PM Mar 23, 2014
All the world's a stage, And all the men and women merely players. - Wm. Shakespeare
There is nothing more real, more sincere than a physician's encounter with each patient. Consequently, it may seem incongruous to look to the profession of acting for lessons on interacting with patients. However, at its essence, a patient encounter, like a scene between actors, involves interpersonal interactions, context, storytelling, and dialogues. The earliest descriptions of acting described in terms of "rhetoric", which is defined as, "the art of discourse, an art that aims to improve the capability of writers or speakers that attempt to inform, persuade, or motivate particular audiences in specific situations."
Is there a more fitting description of a physician visit? Furthermore, like a TV show, movie or play, office visits have a structure to how the story is unfolded. Each visit has its unique plot, and is conducted in "acts". There is the history taking, with its back and forth dialogue (hopefully not a monologue) , followed by, or blended with, the examination, and then the denouement as the diagnosis and treatment plan is revealed. If this structure isn't followed overall, if, for example, the examination is omitted, or the conclusions and treatment plan come at the beginning, then the consumer, the patient (and perhaps the family in attendance) leave disappointed or confused.
There is also "looking the part". One of my classmates in medical school was given a challenging psychiatric patient to see at the VA. New to the rotation, he wore his white coat. He did so, because he had just come off a medicine rotation and did not know that the psychiatrists and teams at the VA did not. When he entered the patient room (stage left) the vet's face brightened. The patient said, "Oh, you're a REAL doctor?". He then proceeded to open up, for the first time, and progress was made in his case. It is for such reasons that there are such lengths as taken to select casting and wardrobe in professional productions.
Some skill sets for actors, such as clarity of speech, emotional facility, body language, improvisation, observation and interpretation all translate very well to critical skills for physicians. However, it was another most critical skill that an internist-actor friend of mine highlighted as the area in which acting has helped him the most as a physician. His feeling is that his acting classes taught him how to listen better, to actively and deeply listen. In turn he feels that this has helped him react and respond with greater depth within the exchange with the patient. This improvement in listening skills has additionally translated into better observation skills.
Some physicians find interpersonal skills to be an intuitive skill set. For the rest acting lessons can be an avenue to more effectively demonstrating the feelings and emotions appropriate to the moment and the encounter. This doesn't mean "faking" emotions, in the least. To the contrary, the better one is dialed into one's own emotions, motivations, and the dynamics of the visit the more appropriately one can demonstrate the compassion and warmth, as well as knowledge that is generally expected.
In today's healthcare environment, in which there is so much pressure on time, distractibility of the EHR, and other interruptions it has only become more challenging to nurture and build upon patient trust. Lessons in body language, eye contact, vocal inflections, facial expressions, movements and even breathing patterns all can improve the tenor, and hence the outcome, of the visit. Such training can improve the perception of empathy, a critical connection between physician and patient. Not just a touchy-feely difference, these practices can also improve the quantity and quality of information gleaned from the encounter.
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