Healing with words
Actors help teach effective doctor-patient communications
Members of the communications team at the Institute for Professionalism and Ethical Practice at Children’s Hospital Boston are (from left) Robert Truog, Elaine Meyer, Elizabeth Rider, Allyson Wall, and David Browning.
As a pediatric emergency medicine doctor at Children's Hospital Boston, Dr. Eric Fleegler is no stranger to difficult situations. Still, one experience stands out in his mind, not because he was able to save a child, but because he was able to "be there" for the parents.
The infant arrived at the emergency room in cardiac arrest. Everything started moving quickly. Fleegler, halfway through his second shift, managed doctors, nurses, and respiratory therapists. As they worked to stabilize the baby, the child's parents stood in a corner alone. Fleegler noticed how frightened they looked. When the baby was out of immediate danger, Fleegler went to the parents and gently took them over to their child. While they touched their child's foot, the doctor softly explained everything that his team had done for the baby. He also gave them a sense of what would happen once their child was taken to the Intensive Care Unit for further care.
All too often, in the hectic high-tech world of modern medicine, this last step never takes place. But the ability to speak compassionately, listen, and empathize with patients and their families is among the most valuable services doctors provide. Doctors say it can be one of the most rewarding parts of the profession.
Studies show good communication also often leads to better patient care. "It isn't just about being nice," says Dr. Elizabeth Rider, director of faculty development for the Institute for Professionalism and Ethical Practice (IPEP) at Children's Hospital Boston, which runs the Program to Enhance Relational and Communication Skills (PERCS). She is also director of the John D. Stoeckle Center for Primary Innovation at Massachusetts General Hospital (MGH). The way doctors relate to patients and their families has lasting effects. When doctors communicate well, patients spend less time in the hospital, are more likely to take their medication correctly, are less likely to file a lawsuit, and are more likely to feel they received high quality care, Rider explains. Doctors, meanwhile, make fewer mistakes and both patients and doctors are more satisfied.
As a growing number of hospitals and medical schools across the country recognize the importance of communication skills, programs that teach them are spreading. PERCS, for instance, was designed to teach clinicians communication and relational skills as well as how to bring their humanity to bear on difficult conversations. Similarly, MGH offers a monthly communication and relationship skillbuilding workshop for doctors (taught by Rider), and courses can be found at Boston Medical Center, University of Massachusetts Medical School, Boston University, and Harvard Medical School, among others.
Many of these programs involve case scenarios in which actors portray patients and family members, giving clinicians a chance to practice and develop their skills. The PERCS scenarios revolve around having difficult conversations with pediatric patients and their families. One scene, for example, requires talking to the parents of a five-year-old boy who has been in a drowning incident; in another, practitioners have to tell parents that their child is about to die of end-stage cancer.
The scenarios are defined in advance, with experienced and novice doctors, nurses, chaplains, and interpreters participating together. Actors are encouraged to improvise. As a result, scenes can unfold in dramatically different ways, depending on what the practitioner says or does. This allows for a rich multidisciplinary learning experience, and, says Fleegler, makes the experience feel very real.
Fleegler, who took the workshop in 2003, said the program allowed him to experiment with different approaches, such as using physical touch as a source of comfort or offering quiet attention. "With the PERCS program, you can see the raw value of just being there and letting people talk," he recalls. "It is amazing how much communication can occur while you are saying very little."
While the scenes play out, Children's Hospital Boston faculty members, including members of actual families of patients, watch over a closed-circuit video feed. Afterward, they come together with participants and actors to debrief.
