Friday, January 27, 2006

Can bedside manners be taught?

Dr. Abigail Zuger, in JS Online, via the OB-Gyne doc at Red State Moron: "A course helps cancer doctors discuss devastating news." (Registration required, sorry.)
Aspen, Colo. - In one room, a woman sobs into her hands after learning that her breast cancer has spread to her liver. Next door, a young man cured of lymphoma two years ago listens impassively to the news that his disease is back. Down the hall, a grizzled, middle-aged hardware store owner hears that despite radiation treatment his prostate cancer is now in his bones.

"You sure of that?" he asks incredulously to the young doctor breaking the news. "You sure those were my films?"

It could be any hospital's outpatient clinic. Instead, it is a small experiment in teaching cancer doctors to do the hardest part of their job: not doling out radiation and chemotherapy but caring for the patients who do not improve with these treatments. The patients in this case are actors, but the doctors are all real: young oncologists who converged at this off-season ski resort for a five-day course in how to talk to patients about the worst possible news...

"The general feeling has been that these are not teachable skills - that either you have it or you don't," said Anthony Back, an oncologist at the Fred Hutchinson Cancer Research Center in Seattle.

Not only do most doctors not have it, Back said, but those who do generally hone their skills by trial and error, saying all the wrong things until they find the right ones, leaving a trail of tangled miscommunications and alienated patients.

Five years ago, Back and four colleagues obtained a $1.4 million grant from the National Cancer Institute to devise a better way.

What they have created is a short immersion course in the language of bad news, one which, like all good language courses, leaves the lecture hall far behind. Instead, students spend their time with native speakers - in this case, four preceptors, or teachers, who are experts in medical communication and five actors who stay in the roles of patients with terminal illness for the duration of the course, each growing sicker as the days go on...

Does this kind of training work?

The actors, all members of the local Aspen acting community, have now watched eight batches of doctors progress through the course and are enthusiastic. "Sometimes the doctors who show up are so bad you say, 'Oh God, this is hopeless,' " Walla said. "Then you watch them actually improve..."
(Someone copied the article here.)


Blogger bp_hockey_chick said...

Having a doctor just tell my mother she has cancer, I only hope it was a doctor who has long since found the better way to deliver impossible news.

3:53 PM  
Blogger Dr Dork said...

I very strongly think communication skills such as this can be taught, and should be taught more.

Even to surgeons ;-)

What do you think, shrinkette ?

5:10 AM  
Blogger shrinkette said...

I agree with you, Dr. D!

8:51 PM  
Blogger Dr Dork said...

BTW thanks for adding me to your bloglist, Shrinkette.

I'm honoured.


4:29 AM  
Blogger Joel said...

If patients' lives can be improved by teaching them to reframe, why shouldn't we believe that bedside manners can be taught?

2:36 PM  

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