Point of View

Medical training must start including the art of communication

May 14, 2014 

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MARK WRAGG — Getty Images/iStockphoto

On Saturday, I woke up a medical student and ended the day a doctor. After 20 years of schooling, most of which were spent memorizing facts and taking tests, I finally started my career caring for patients. And I’m not sure I’m prepared.

“The art of medicine” is a phrase commonly used by physicians to describe doctoring. It highlights all of the “soft science” and the unknown that come with treating patients. Art is inexact, emotional and subjective. So is medicine –more often than we would like to admit.

Like art, good medicine is subtle.

“You’ll know it when you see it,” we’re often told.

However, with more than 800,000 physicians practicing in the U.S., this hands-off approach to teaching the art of medicine is not good enough.

In medical school, we spend two years learning everything from how our DNA is stored to how congestive heart failure progresses. Then, for the next two years, we go into the hospital and learn what symptoms to look for, what tests to order and how to treat diseases.

We gather patient histories, do our best with physical exams and help out in the operating room. We are continually tested on our medical knowledge, but for the most part the task of learning how to communicate with patients is left up to us.

We are expected to learn by example, learn by osmosis, just learn somehow. But these are not simple things, and we don’t always have good role models. Furthermore, as our health care system puts increased emphasis on patient-centered care and shared decision-making, these communication skills even more vital.

There’s no question that we have come a long way in the last few decades. The arrogant doctor is a specter that all medical students are warned against, and many medical schools require students to start practicing our interviewing skills early on.

But that’s not enough. Ask any graduating medical student to list the signs of a heart attack, and she’ll be able to tell you what to look for in women, men, diabetics and the elderly. Then ask how she would go about telling a family member that their loved one has died, and she would fumble along at best.

Part of the problem is that it is hard to teach art. It is hard to explain how to read patients’ moods or what to say when they are really scared. But just as a heart attack can present in many different ways in different people, there are strategies and formulas that can give students tools to work with.

Some medical schools require students to practice telling patients about a medical error, and others get actors to help students practice delivering bad news. These supplemental lessons, however, are tacked on to the core clinical experience, and the message is clear: The technical knowledge comes first, and hopefully at some point you’ll pick up on the art.

Yet “the art of medicine” is the intertwining of both. A great doctor is one who is able to demonstrate her technical know-how through compassionate interactions. We cannot be effective doctors if we cannot connect with our patients and earn their trust. For some, these interpersonal skills may develop on their own through years of experience, but why leave it up to chance?

Why not require medical students to participate in a death notification, as we are required to participate in the operating rooms? Why not test and grade us on our ability to ask the awkward questions, have the hard conversations and express empathy?

Our patients certainly will, and for them, this may be the real grade that matters.

Nancy Wang, M.D.,

lives in Chapel Hill.

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