Take an Acting Class

Ok, so anyone who knows me understands that I always like to shake things up. I don't know if OHSU was really aware of that when they decided to offer me a seat in their incoming medical school class, but here I am! My latest gripe has to do with how we are being taught to interact with patients, get their histories, and show empathy. It is not that I think we are being taught bad or incorrect things, I just feel that the class structure is putting the horse before the cart. And I think that this is problematic.

The latest criticism of mine is centered around a technique we are learning which is called the BATHE technique. BATHE stands for: Background, Affect, Trouble, Handling, and Empathy. This is a simple acronym that we are keeping in our heads to help us elicit a better history from our patients and better get to the root of some of their problems, particularly problems that are presenting themselves physically but have a psychological root (stress, anxiety, depression, etc.) This is a really good thing! If more physicians had the time and capability to implement this strategy, I'm sure that many patients would be helped.

Now, our teachers have of course pointed out that this is a rather simplistic and robotic way to interact with people. If you followed along these steps exactly, you are likely to sound more like a robot than like a physician. And this is what gets to the root of my problem. This "checklist" is, I think, the second step in the conversation, not the first. Maybe it is my theater background rearing its head, but I believe that it would be more helpful to start with an actual workshop on listening. This is a key first step in improvisation acting, which is what we are doing in a sense when we are interacting with our patients.

Now, we did start the semester by talking about the importance of listening to our patients. But, the thing is, we never truly worked on it. We never had an instructor (in this case, I would argue the instructor should be an acting coach, not a doctor) insert us into situations and have us work on listening and reacting appropriately. When you are truly listening, your thinking is different, your being is different, your physical presence is different. To say to yourself that you will listen does not mean that you are. Every half decent actor knows how to listen, but I am not convinced yet that most doctors do, and I believe that most Americans can agree with me on this one.

I feel like our classes are trying to get to this place, but it isn't there yet. We do "play act" with each other, but it does not remotely compare to the intensity of the real thing. If we don't all learn what it truly means to listen to our patients (and to each other) than taking part in something like the BATHE technique will just be window dressing, and the patient will see it for that. Learning these skills are hard, and I think that the time needs to be devoted to these fundamentals. We all could use the practice.

Pharm Free

Next week in National Pharm Free week, and I just found out a few days ago that I will be the coordinator for the activities at OHSU. It is a little crazy, but it looks like we are going to pull it off.

Let me start by saying that "Pharm Free" is a terrible name. It implies that you would like to treat all of your patients without the aid of pharmaceuticals. Obviously, this is not the case (would make being in med school pretty hard, no?) Pharm Free is all about reducing the influence of marketing on the physician/patient relationship in an effort to bring down the costs of pharmaceuticals (and healthcare in general) while also working to restore some of the physician/patient trust that has eroded over the years through the "business-ification" of medicine.

"What is wrong with business and making money?" you might ask. Well, nothing really. However, the relationship between physician and patient is supposed to be about something more, from what I both understand (and am taught weekly in my PCM course) and what I aspire towards. People come to a doctor's office, often in a very vulnerable state. They share with their physician some of the most intimate details of their lives...heck, they are already sharing these details with me and I've only been a medical student for a month and a half! As a result, I feel, and I am constantly being taught that, a physician's role is supposed to be to "Do good" not to "Do well."

In society today, we are constantly exposed to images that go against this basic premise. This serves to undermine this delicate and all important trust. TV reality shows are full of doctors anymore who are seeking both glory and a fat paycheck. The media latches onto stories about irresponsible and sensational doctors (e.g., "Patient sues doctor after he cuts off man's penis!") And our expensive medical bills cause all of us to wonder why some doctors are making over $500k a year, while their patients are filing for bankruptcy. Also, the current role of pharmaceutical companies in patient care is a constant specter hanging over the state of medical care in the US. All of these problems are substantial and eat away at that basic trust that must exist between a doctor and a patient in order for medical care to be effective.

Pharm Free Week, is simple but profound grassroots initiative that addresses one of these problems. We will be working during the week to have medical students sign the Pharm Free Pledge (http://www.amsa.org/prof/pledge.cfm). This simple pledge will plant the seed in the minds of future physicians that it might not be in their patient's best interest to accept that free lunch, golf trip, or conference in the Bahamas, from a Pharma company. I believe that most, average people see these perks for what they are: bribes. That is unfortunate. That eats away at the physician/patient relationship. That helps to reduce the effectiveness of medical care in this country.

In addition to taking the pledge, we will also be handing out stickers so we can "liberate" the drug pens that so many healthcare workers use to do their work. While it might not be like your doctor walking into the examination room with a big "Prozac" sweatshirt and cap on, simply using a pen with that same drug name implies something. The patient needs to know that the doctor is 100% on their side, and not prescribing them a certain drug because they will get a "kick back" as a result.

Anyway, that is enough of me standing on the soapbox for today. Here is the Pharm Free website if any of you out there are interested and want to make a change in your own small, grassroots way (http://www.amsa.org/prof/pharmfree.cfm).