First year medical student Aneta Kowalski knocked on the door of the classroom. Upon entering, she used sanitizer to clean her hands and introduced herself to the patient, Brandi Welle.
Kowalski and Welle sat down and began to talk. Welle said that she was in a car accident four years ago. She was suffering from hip pain and was dependent on pain killers. But she also no longer has a prescription and had been dropped by several doctors for her dependency.
“I think I have a problem,” Welle told Kowalski. “I think I need some help."
Given Pennsylvania's on-going opioid crisis, this is a conversation that is playing out in doctors' offices across the state, but this one is just for practice — Welle was an actor, and the classroom was filled with Kowalski's peers and her teacher. They're all there to give feedback on how she interacts with the patient.
Welle is a standardized patient. It’s a program the University of Pittsburgh School of Medicine uses to give students hands-on experience dealing with patients. It’s been used as far back as 1964 when an educator at the University of Southern California coached patients to simulate symptoms. Pitt has used the program in some form since 2001.
Using actors to improve health care
During the fourth year of medical school, a student has to pass a national exam to move on to residency. That exam now includes interviewing a standardized patient.
Dr. Reed Van Deusen, the medical director of Pitt’s standardized patient program, said that national exam will put more emphasis on interpersonal communication skills during the next few years. That's not surprising, given that a study published in April of this year in the Journal of Medical Practice Management found that customer service is the number one health care complaint.
Welle has been a standardized patient for six years. Before the class started, she sat in a room with other actors playing the same character.
Van Deusen told them to portray skepticism when the students ask them questions. He told them they’ve been burned by doctors in the past. He said he doesn’t want them to be difficult, but just ambivalent.
In the classroom, Kowalski told the patient she was sorry to hear about the persistent pain.
“It must be a really difficult experience,” she said. “I really hope that we can find an alternative option and really try to help you.”
Dr. Jared Chiarchiaro, the instructor, paused the scenario. He told Kowalski that she was skillfully using her words to tap into the patient’s emotional concerns. It’s a behavior he often reinforces. He told her repeatedly how her words are important in building trust with the patient. Because, he said, doctors have very limited time with patients and earning respect in a short amount of time is challenging.
Kowalski told the patient she would like to talk about solutions. Chiarchiaro paused the scene again and said he saw relief in the patient.
“You had a very empathetic statement,” he said. “You showed her that you get it and then you showed her that you’re here to help find a solution.”
The power of empathy
The first year of medical school covers a lot of anatomy and memorization. But that’s not why most people become doctors. They want to help people.
At the end of the class, Chiarchiaro asked the students how many of them wrote in their medical school application that they wanted to be a doctor in order to gather and report medical facts. No one raised a hand.
“Sitting down with somebody, taking a couple of minutes and just talking with them and connecting with them in a real genuine way is meaningful and it’s got its own … healing power behind it,” he said.
He said residents or attending physicians often complain they don’t get anywhere with a patient because the patient is being difficult. That, he said, comes from the doctor feeling helpless.
“But if we can show them that there are some skills they can learn and that if they do something differently and they’ll get a better response, well that takes away that helplessness and gives them some empowerment,” he said. “They’ll undoubtedly have better experiences and connections with their patients and their patient’s families.”
Van Deusen compares teaching empathy to riding a bike – some students come in on a tricycle, some are already on a road bike. It’s something that can be taught, but they need tools like how to name an emotion.
“Saying ‘that must be frustrating’ or ‘I can’t imagine how you’ve been coping with that’,” he said.
A doctor's response to a patient also has to be genuine. If they take the time to have a meaningful connection, that can lead to a more accurate diagnosis. Van Deusen said in turn, a positive outcome can lessen the chance a physician will burn out from the stress of the job.
Health care coverage on 90.5 WESA is made possible in part by a grant from the Jewish Healthcare Foundation
