Surgery News - September 2007 - (Page 11) SEPTEMBER 2007 • SURGERY NEWS PRACTICE TRENDS 11 Empathy Training Eases Difficult Discussions BY DAMIAN MCNAMARA Else vier Global Medical Ne ws W hen delivering bad news to patients, not only what you say, but how you say it, is important, according to researchers involved in an innovative pilot program at Virginia Commonwealth University. Teaching physicians the importance of nonverbal skills produced measurable improvements in communication among internal medicine residents participating in the program, said the researchers, who will offer the training to surgery residents and nurses in the fall. “Initially, we were interested in incorporating actors into skills sessions where we could assess and evaluate not only medical knowledge and patient care, but communication skills and professionalism as well,” said Susan C. Haynes, education programs administrator with the department of surgery at Virginia Commonwealth University (VCU) in Richmond. “We discussed how communication tools readily used by actors, such as listening skills, body language, and tone of voice, are the same tools that could be used by a physician to enhance patient care and collegial relationships.” Some program participants were receptive, while others were skeptical, said Dr. Alan Dow, an internist at VCU who conceived the 4-week course with David Leong, chair of VCU’s theater department, and Aaron Anderson, Ph.D., associate professor of theater. “Some said, ‘I feel like I know how to talk to patients.’ We gave them suggestions to try with patients, and they found it helped. They became big believers,” said Dr. Dow, who also is associate director of residency training at VCU. The researchers observed physicians interacting with patients before and after the training. They also surveyed patients, asking questions such as What makes a good doctor? How does a good doctor make you feel? Have you had any experiences with a bad doctor? If so, how does it make you feel? “Of more than 400 responses, only 2%3% [said being a good doctor] had to do with medical outcomes. How physicians listened to them was more important,” Mr. Leong said. “Delivering news that the results of a test or biopsy have confirmed a life-threatening disease or the recurrence of cancer are both potential possibilities for the surgeon. There’s also the possibility of finding yourself . .. explaining an unanticipated bad outcome,” said Dr. Brian J. Kaplan, an ACS Fellow and vice chair of surgery education and director of the general surgery residency program at VCU. He said he believes the new training could help surgeons in delicate situations and perhaps also improve more routine clinical communication. Dr. Thomas Russell, executive director of the American College of Surgeons (ACS), concurs. “Surgery often involves difficult cases, such as a trauma patient coming from a car accident to the OR. Suddenly the family gathers and has to be talked to. Who is going to do this?” If patients and their loved ones are anxious or grief stricken, they will absorb very little clinical information. “It can be very emotional. We need to understand what they are going through,” said Dr. Russell, an ACS Fellow. He emphasized the importance of empathy, especially when discussing malignancies or end-of-life issues. The ACS has didactic materials and educational CDs that could be incorporated into formal training programs, and a symposium on end-of-life care will be offered in November (see story on p. 13). “It’s hard for patients to evaluate the technical skills of a surgeon,” Dr. Russell said. “But how a doctor comes across to a patient is really something they can judge and their family can judge.” “In theater, we teach people how to listen well,” Mr. Leong said. The theater department also can teach physicians to use nonverbal skills to impart empathy. This is important, he said, because 55% of all communication is passed to another person through body language, another 38% through tone of voice, and only 7% through the words themselves. Dr. Dow said he learned “a ton” from the experience. “You become more aware of communication and the nonspoken components, such as posture, positioning relative to a patient, what your body language is saying, and what the patient’s body language is saying.” How information is structured is very important to how bad news is received, said Dr. Anderson. “There are only a few ways to deliver [bad news] right and a million ways to do it wrong.” ■ NOW AVAILABLE : ATLS FOR DOCTORS STUDENT MANUAL, 7TH EDITION The ATLS® Program was developed to teach doctors one safe, reliable method for assessing and initially managing the trauma patient. The course teaches an organized approach for evaluation and management of seriously injured patients and offers a foundation of common knowledge for all members of the trauma team. The emphasis is on the critical “first hour” of care, focusing on initial assessment, lifesaving intervention, reevaluation, stabilization, and, when needed, transfer to a trauma center. This publication, in its 7th edition, was written for use in ATLS Student Courses and is updated approximately every four years. Price: $80 each To obtain an ATLS for Doctors Student Manual, visit the American College of Surgeons online publication catalog at: https://web2.facs.org/timssnet464/acspub/frontpage. cfm?product_class=trauma https://web2.facs.org/timssnet464/acspub/frontpage.cfm?product_class=trauma https://web2.facs.org/timssnet464/acspub/frontpage.cfm?product_class=trauma
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