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Communication Barriers

image of a car crash 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. comments Share your thoughts: What could your doctor's office do better? What could your patients do better? Read submitted comments.

Learn How to Explain Yourself

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.

Emapthy

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." Through discussions and interviews with patients and providers, Cole came up with a curriculum and a list of communication complaints and solutions that exist on both sides of the examining table: “What do you think you have?” “I dunno, you're the doctor, you tell me.”

Communication Breakdowns

Cole says that doctors note the following patient communication breakdowns:

The Scene

“You're fine. See you next year.” “But, I have a ques?” Door slams. Cole says that patients note the following medical- communication breakdowns:

If our car mechanics dismissed us and our rumbling engines with a brusque wave and grunt, we would never go back. And, as mechanics, if our customers roared in, demanded our attention, then stonewalled us when we asked what was wrong with the car, we’d find empathy hard to muster. After all, Cole reminds us, “All physicians will be future patients; all patients will be future caregivers. Learn from each other, now.”

Effective Patient-caregiver Communication

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."

Other Approaches

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:

Have Questions Written Down

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

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