On communication

I love this study, which comes from my alma mater.Doctors gain insight from theater training

The art of effective communication, considered a key attribute of a good physician, is one aspect of medical training that often is not dealt with explicitly, said Alan Dow, MD, associate internal medicine residency director at the VCU Medical Center.

This is why this seemingly disparate group of individuals have joined forces. The theater professors, armed with their understanding of verbal and nonverbal communication, are collaborating with VCU Medical Center physicians to turn medical residents into effective communicators able to build trust with patients and get to the heart of patients’ clinical concerns.

Pilot program results in the August Journal of General Internal Medicine show that the class seems to have made a difference in physician-patient communication. Trained observers rated residents’ overall empathetic communication 6.88 on a 10-point scale before the class and 8.56 four months later. That compares with a control group where the rating slipped from 6.38 to 5.82 in the same time frame.

“Communication skills are important, but we’ve forgotten how to teach them,” said study co-author Dr. Dow. “It’s an area we don’t know much about.”

As students, physicians learn that they should make eye contact and ask open-ended questions, Dr. Dow said. But the curriculum he and several VCU theater faculty developed delves more deeply into doctor-patient interactions.

The program walks residents through communication’s key elements. To build clinical empathy — the ability to recognize a patient’s emotional state and respond in the moment for a better clinical outcome — the team emphasized being present in a conversation and practical how-tos for observing a patient’s emotional state.

“Ninety-three percent of information that is conveyed is through body language, tone of voice,” said David Leong, VCU theater department chair and co-author of study. “What is said is only 7% of the equation.”

How many clinician educators understand these issues? How often do we serve as positive role models for patient communication?

As we consider high quality doctoring, does not this factor into the equation? How do we measure this? Perhaps we could ask patients, although we do know that patients tend to like their physicians, almost regardless of competency in many dimensions.

I applaud this study, and look forward to further reports on teaching residents (and hopefully practicing physicians) how to better communicate with patients.