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What's Working

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Actors Help Physicians Hone Communications Skills

  What's Working - Winter 2011 - Close-up
 

Actress Beverly Swenson plays "Erma Johnson" to help new physicians hone communications skills.

By Rebecca Jones
Photography by John Johnston

It was a pain in her side that brought "Erma Johnson" in for a checkup, but it was the pain in her neck – her son – who she was busy describing to the doctor.

"My son is always prying," she complains. "It seems like he wants to run my life."

"He's probably just concerned about you," the young resident says, suspecting that Erma's son wasn't nearly as much of a problem as were Erma's three to four nightly cocktails. The alcohol was probably causing Erma's gastritis and almost certainly contributed to the cast on Erma's leg: She had fallen off a stool.

"My recommendation is that you talk to someone about your alcohol use – even if you're not ready to quit drinking," the resident says. "We have a lot of resources we can put you in touch with, like Alcoholics Anonymous."

Ten minutes later, still in the exam room, Erma was the one assessing the resident.

"You did great. You summarized often. You got right to the point of my problem – my drinking," she says. "I know it's hard for a young person to address something like that with someone old enough to be your grandmother. And when I said it would be hard for me to stop, you said you would be here for me. I felt like we could get to the bottom of it."

"You might have asked a little more about my family history," Erma chastises gently. "My father was an alcoholic, and that's important."

"Erma" is actually an actor, Beverly Swenson. Swenson's been playing "Erma the alcoholic" for five years now. She's one of about 60 actors recruited by the Center for Advancing Professional Excellence, a part of the University of Colorado School of Medicine. The center specializes in the use of "standardized patients" – actors trained to give lifelike portrayals of people with specific histories and complaints – to help young doctors polish their diagnostic and communication skills.

After all, communication is a two-way street: If people are to be truly engaged participants in their health and health care, they need to know that their health providers are listening and responding.

"Doctors have to be able to communicate in a relational, patient-centered approach," says Gwyn Barley, PhD, associate professor at the medical school and director of the center. Many of the exercises are geared to primary care physicians – including the internal medicine residents at Presbyterian/St. Luke's Medical Center, the family practice residents at Swedish and Rose medical centers and other residency programs in the state.

"The primary care folks are definitely stepping out in front of this movement. They understand that communication is such a core skill," Barley says.

Brian Dwinnell, MD, internist and director of Graduate Medical Education at Presbyterian/St. Luke's, this year is putting his residents through such exercises to address some perceived gaps in their medical curriculum. One exercise addresses patient safety and disclosing medical errors. The other is an exercise in delivering bad news.

"Within seconds you forget that they're actors," Dwinnell says. "They're that good. Believe me, you come out of this sweating. These are emotional encounters, and the patient can get angry, tearful. And more than once, residents have become emotional themselves. It's embarrassing to them, but the patients will reinforce that they appreciate it, that they want to see a doctor who cares that much."

The sessions are videotaped, and faculty members observe the interaction in the room or by camera, evaluating each encounter: Did the doctor ask open-ended questions? Show empathy? Check to make sure the patient understands? Later, the young doctors can learn by watching their performances.

"It really develops skills in self-reflection," says Dwinnell, who notes that most doctors don't enjoy the exercises but afterward usually rank them as valuable learning tools.

"There's been a shift away from the art of the healer to the science of biomedical technique," Dwinnell says. "But being competent in biomedical technique is only half a physician's job. Nearly everyone who sees a doctor is concerned about something. And if you can't address those concerns, then you're not doing your job."

EDITOR'S NOTE: In 2009, the Colorado Health Foundation invested $12.3 million in graduate medical education programs, including the programs at Presbyterian/St. Luke's, Swedish and Rose medical centers. The Foundation funds residency programs that provide structured, regulated, supervised and competency-based training of medical school graduates.