Scene opens on a man and woman seated opposite each other with folded arms and hostile expressions.

“He doesn't listen to a word I say.”
“I would, but she doesn't talk.”
“Why bother? You don't even look at me.”

Just another couple with their marriage counselor, huh. Wrong, and maybe worse: just another patient with their doctor. And like any relationship, it takes two to communicate—and two to misunderstand. Can this doctor's appointment be saved?

Ask Megan Cole, an actor—and visiting professor at The University of Texas Medical School at Houston—who is an expert in communication. She uses her well-honed talents to teach doctors how to "get into the minds of their patients, much like an actor who must reach into a character to understand the role." Some doctors have trouble communicating with their patients, just as some patients do with their doctors.

Reaching into the actor's tool kit, Cole teaches health care students and physicians how to talk, listen and relate to their patients. "But, it's a two-way street here. Patients must learn how to explain themselves, their symptoms, so that they can be helped," Cole adds.

Cole conducts her workshops and seminars for faculty and students as artist-in-residence through the UT John P. McGovern, M.D. Center for Health, Humanities and the Human Spirit.

The idea for a course in "empathy" began after Cole performed the groundbreaking stage play "Wit" in Houston. Cole originated the role in 1995 of the cancer patient whose emotional transformation occurs through exchanges between her and her doctors. Post-performance discussions between patients and doctors in the audience "moved me and I, too was transformed by the experience. I wondered what I could do to use my acting skills in a specifically useful way to help others."

Cole teaches that the art of empathic listening is core to effective patient-caregiver communication. Health care professionals and patients are in relationships every bit as intimate and personal as familial ones-- even if they’ve never met before. And though both are working toward the same goal of restoring or maintaining health to the patient, both bring their own history, personality, daily stressors and worries to the encounter. The patients are terrified; the doctors are overworked. As one cancer survivor recalls, "You wait three hours naked, hairless, nauseated, and scared for yet another exhausted, HMO-jaded doctor to come in for three minutes, yawn, mispronounce your name, and leave."

Cole uses an "as if" approach to understanding each other. "In acting, even though we may not be exactly like a character, we can behave 'as if' we were that person. So if I want to be compassionate, as well as a skilled nurse, I will learn to act 'as if' I were those things."

Body language, vocal tone, physical touch, and spatial relationships (how close or far we place ourselves to someone else) speak louder than our words. Cole stresses that what we say or do may not be nearly as important as how we say or do it.

“So, John, let's sit down together and come up with an attack plan for these headaches...”
Cole recommends these communication skills for health care providers:

• Knock on the door and wait for a response before entering.
• Smile, shake hands and use the patient's name.
• Sit eye-level or lower than the patient.
• Sit 2 to 4 feet from the patient with no furniture obstacles between you.
• Allow the patient to get personally organized.
• Look through your glasses at the patient, not over or under.
• Ask more open-ended questions. (“So, tell me about your job.")
• Listen actively: nod, maintain eye-contact, limit note-taking.
• Allow for thoughtful silences without feeling a need to fill in with conversation.
• Show you’re hearing the patient by repeating phrases and reiterating.
• Always acknowledge the patient's emotion before proceeding to the next issue.
• See this person as a human being, not a disease process.
• Remember, one day this may be you, your child, or your mother.

“I have a list of questions and I have written them down…”
Cole's recommended communication skills for patients:

• Remember that a waiting room is just that. There are many patients and only one doctor. Sometimes you can't schedule your stomach flu.
• Take the medical history questionnaire seriously. Leave nothing out, and what you don't know, make a point to find out for future visits.
• Allow for silences between questions and answers.
• Tell the doctor what you need from her. She is not a mind reader.
• Describe your symptoms clearly. She does not have x-ray vision.
• Listen actively: maintain eye-contact, let the doctor finish the explanation.
• Bring another set of ears with you if necessary. Let them take notes.
• Empower yourself with information from the Internet, but don't compete with your doctor.
• Tell your doctor that you are frightened, angry or confused. Do not proceed to the next issue until these emotions have been addressed.
• Share your lifestyle habits and secrets. Your doctor is not your mother or your judge.
• Thank the staff for their help. It takes up to five staff members to see one patient.
• See the care provider as a human being, not just as "the assigned physician referral."

UPDATED: 6-06-2007

 

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