Sunday, December 11, 2016

Recognize Vulnerability, Stress Empathy

In the seventh grade we were given an aptitude test. The questions measured our desire undertake certain tasks as well as our ability to carry them out. When the results were processed and returned there were two things I was best suited for:

Artistic Expression

I’ve never been able to remember in which order these were listed, but I do recall their scores were rather close together. I remember thinking how divided these paths were. Apparently I was equally suited to run a soup kitchen or write a novel, though it didn’t seem to me I’d be able to pursue both. We were only allowed one elective a year.

In the end it was the artistic expression that won out. After a couple of false starts, I’ve spent the last twelve, maybe thirteen years trying to make a sustainable acting career. Some years are more successful than others.

I’ve always had an itch to do something more important.

A few years ago my Lady Love suggested I try a gig that several fellow Chicago actors have been doing for extra cash: working as a standardized patient. Most medical universities have such a program whereby their students can practice their communication, physical exam, and diagnostic skills on a real live human being. It helps them to work on a stranger, who is an average layperson, instead of a colleague or instructor.

There’s an area of the school designed to look like a clinic. Examination rooms line a carpeted hallway. In each room there’s a standard set of basic equipment: blood pressure cuff;  wall-mounted thermometer; That Thing they use to shine a light into your nose, your ears, your eyes. A glass jar full of tongue depressors. A reflex hammer.

I’ll sit on a narrow exam table, in a thin gown, waiting for a student to knock and enter the room. My street clothes hang on a set of hooks by the door. Based on the questions they ask I give them a series of answers (carefully scripted by their educators) based around a chief complaint. Shortness of breath, ankle pain, persistent cough, “it hurts when I do this.” If they ask the right questions, they get the answers which lead them to conduct the tests which lead them to the correct diagnosis.

A typical exam gives the students five patients to examine. After their first, third, and fifth encounters, we drop the patient persona and give them feedback on their communication skills. Essentially we’re coaching them on their bedside manner through a combination of objective criteria (as defined by the school) and subjective (as defined by We the Standardized Patients).  

I’m very fortunate to have rarely had a need to see a doctor. Most of my experience has been vicarious as I’ve shown up to provide emotional support for someone I care about. For each and every person I know who voiced a complaint about going to the doctor, it’s always been on the same topic: the way they were personally treated by the staff. They felt belittled, judged. They felt like no one cared. They didn’t want to go back no matter how sick they felt or how much pain they were in.

These are the memories I carry with me during the communication feedback sessions. Nearly every student I speak with expresses a desire to make a personal, human connection with their patient. Many of them get stuck on how to do that while simultaneously trying to determine cause of their complaint and how to treat it.

Unless there’s a more pressing issue to discuss I always stress the same two elements to every student. I’ve said it so many times now that it’s become a script:

The very nature of the fact that a patient is sitting in your office means that something has gone wrong in their day. They’re uncomfortable, they’re in pain, they’re probably scared to some degree. This room is not where I want to spend my day. This gown is not how I like to dress when I meet somebody for the first time. It’s an incredibly vulnerable position for your patient to be in. Especially compared to you – you’re at your job, you’re in your element, you’re dressed professionally. The key in making a human connection is to recognize that vulnerability, then bridge the gap with an empathetic connection. Tell them, “I’m sorry you’re feeling this way. We’re going to do our best to find out what’s wrong, and get it taken care of, and get you back to your day.” If you make that the foundation of all your communication, it creates a partnership, fosters a trusting environment for your patient to tell you the things you need to know to make your diagnosis and find the best treatment plan.

I never did become a professional caretaker, and I probably never will . . . but I can help other people do it. Like Sam said to Frodo, “I can't carry it for you, but I can carry you.”

And I can use my acting skills to do it, and that’s gratifying.

And I can earn a paycheck doing it, and that’s satisfying.

And lots of people get to see my back tattoos. They get extra credit for telling me how cool they are.

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