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.