September 07, 2007

Theater Classes Help Docs' Bedside Manners

FRIDAY, Sept. 7 (HealthDay News) -- New evidence suggests that a bit of theatrics can help doctors become better caregivers.

The finding is based on the experience of a small group of internal medicine residents who went through six hours of theater workshops and lectures led by university theater professors.

Focus was placed on the impact that body language, eye contact, verbal cues and attentiveness have on patient-doctor communications, and the skills taught appeared to significantly improve both a physician's bedside manner and patient trust.

"We're not trying to teach doctors to be actors," said Dr. Alan Dow, an associate director of residency training at the Virginia Commonwealth University VCU) Medical Center, in Richmond, Va. "But there are some valuable communication skills that doctors are just not learning and that the medical education system is just not thinking about right now. And we thought that a lot of the stuff that's being taught to theater students is very similar to what doctors could benefit from in terms of communicating with patients."

The report is published in the August issue of the Journal of General Internal Medicine.

As a combined effort between VCU's internal medicine and theater departments, Dow teamed up with theater professor Aaron Anderson in 2004 to design a program geared to the patient-doctor dynamic as experienced by 14 medical residents, nearly three-quarters of whom were women.

Four theater professors held four 90-minute classes that identified the need for establishing patient trust.

In addition to attending lectures, the residents also engaged in role-playing, some of which involved residents "acting," with teachers playing the part of patients.

They also stressed the importance of the subtle but powerful role that body language, eye contact, vocal inflection, breathing rhythms and overall expressiveness can have on building a good relationship with patients.

All 14 residents -- at an average age of 30 -- were observed during a primary-care clinic visit at least once before the theater training and again at least once after the course. Another six residents received no theater training but had similar evaluations.

The researchers found that, in almost all respects, residents exposed to theater training were appreciably better at communicating with their patients than they had been before the training. Theatrically trained residents scored significantly better post-workshops in almost every aspect of empathy skills than their non-trained colleagues.

Although more research is needed, the team called for the creation of courses for medical students that stress the value of developing empathy skills.

"Right now, doctor-patient interactions are often very fact-based," noted Dow. "But there's a lot of emotion and nuance that is also part of that communication, and that is really the art of medicine -- rather than the technical aspect of what doctors do."

"And there's also the idea of being present in the moment with the patient, which is a difficult task," he acknowledged. "As a physician, you're going to be talking to that patient and worried about another patient who's much sicker, and you're going to be getting paged, and worried about all your personal things, work and non-work demands. But doctors need to realize that, and say 'OK, when I'm in front of a patient, I need to belong to that patient and be present with them, and then I can worry about that stuff later.'"

"Because," added Dow, "we know that focusing and understanding the emotion and the viewpoint of the patient leads to all sorts of better things. You get better information, you form stronger relationships, patients are more likely to listen to you -- get the prescriptions filled and engage in follow-up -- and doctors are less likely to get sued. All the things that doctors really want to have happen but generally haven't been good at making happen so far."

Dr. Eric B. Larson, an internist and executive director of the Group Health Center for Health Studies in Seattle, expressed little surprise with the findings.

"In acting, you learn techniques to manage your emotions and especially the way you display your emotions," he said. "It is a skill, just like anything, that you can be better or worse at. And being good at it helps you do a better job of caring and healing."

"Patients want and expect to have a warm, understanding human relationship with their physician, where a doctor can feel with the patient the patient's experience," Larson added. "This is what it's all about."

More information

For more on bedside manners, visit the American Medical Association.

SOURCES: Alan Dow, M.D., associate director, residency training, and assistant professor, internal medicine, Virginia Commonwealth University Medical Center, Richmond, Va.; Eric B. Larson, M.D., internist and executive director, Group Health Center for Health Studies, Seattle, and past president, Society of General Internal Medicine; August 2007, Journal of General Internal Medicine
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