The year 2000 will likely be remembered in medical history for the mapping of the first draft of the human genome. But for many medical educators teaching tomorrow’s doctors, the focus today is not on new technologies, drugs and discoveries. Instead, they say, the emphasis is on empathy.
Teaching empathy, effective communication and caring is not new to medical schools, but those topics are getting more attention and more space in medical school curriculums in the 21st Century.
In fact, the National Board of Medical Educators plans to add a doctor-patient communication component to what is now a computer-only licensing test sometime next year. Add an increasingly diverse population, combined with a rise in medical malpractice suits and a growing sensitivity to patients’ needs, and schools have seen enough signals to know it’s time to teach doctors to talk — and to listen.
“Twenty years ago only 35 percent of medical schools had explicit communications skills classes,” says Dr. Mack Lipkin, professor of medicine and director of the division of primary care at the New York University School of Medicine in Manhattan.
Today, the Association of American Medical Colleges, a nonprofit association that sets the agenda for medical education for the 141 accredited U.S. and Canadian medical schools and more than 400 major teaching hospitals and health systems, says all schools do. According to AAMC public opinion research, patients rate communication as the most important factor in choosing a new doctor at 85 percent, ahead of board certification, number of years of practice and where a doctor attended medical school.
Learning to Listen
“All too often medical students and physicians do not listen to their patients. But the history a patient tells is more important than the physical examination,” says Dr. Mark Schwartz, founder and director of The Morchand Center for Clinical Competence at Mount Sinai Medical School in Manhattan, a center created in 1991 to train medical students to become compassionate physicians.
But teaching students how to talk and listen is not as simple as it may sound.
“It’s a more complex, richer environment medicine is being practiced in today,” explains Dr. Deborah Danoff, assistant vice president of the division of medical education at AAMC. “It’s not just one White Anglo-Saxon Protestant explaining things to another White Anglo-Saxon Protestant anymore.”
Emotionally-laden issues like religion, or value-laden ones, like recreational drug use, sexuality and sexual behavior, and even smoking, can be hard for young doctors to deal with, Danoff points out. The topics become even more difficult to discuss when a patient either does not speak English or has a different belief system.
A person’s medical history is important because it offers clues about lifestyle and habits that directly impact the way a patient ought to be treated, Schwartz says. Knowing how to hear the clues — and follow them up — is critical to the patient’s care, he says.
Many communication classes at medical schools break down doctor-patient communication into five basic skills — establishing a relationship, gathering information, giving information, negotiating a treatment and closing a session. These programs also put students in a simulated clinical setting with a standardized patient, or trained actor, to work on these different aptitudes.
Simulated Clinical Settings Educate