Truly Listening
by Jon Nalick
In an old joke, a psychiatrist heads home for the day with a broad smile across his face and not a care in the world.
An amazed acquaintance asks, "How can you listen to people's problems all day long and go home so happy?"
The psychiatrist chuckles and answers, "Who listens?"
As the joke suggests, the feeling that many medical professionals lack sufficient empathy for their patients is common enough to serve as a reliable punch line.
But a newly revised curriculum at the Keck School of Medicine of USC designed to increase the relevance of medical education also places a premium on compassion. The new curriculum provides guidance to ensure that the physicians it trains keep the focus on listening to patients and treating them as individuals instead of merely treating their ailments.
Erin Quinn, Ph.D., associate dean for admissions at the Keck School, says that the new curriculum seeks to infuse ethics, communication skills and professionalism into every aspect of the training.
"All those things are important because without them, medicine may as well be robotics-looking at humans as if they were just batches of components and you were just fixing a machine," she says. "Without an understanding that the mind and human spirit have a great deal to do with healing the body, you have the science of medicine, but you lose the art of medicine."
Keck School officials spent five years redesigning the curriculum and the first class of medical students trained under the new system will graduate in 2005.
Under the new curriculum students receive much more practical clinical experience with patients in their first year. Further, students are now graded, in part, by how effectively they interact and communicate with patients.
"They know they won't advance unless they can go in and interview a patient and ask the right questions in a non-judgmental fashion, elicit patient responses and show consideration," she says.
Moreover, students are also graded on how well they communicate with others on the treatment team, because, Quinn notes, "It's important not to be the Lone Ranger out there."
Pamela Schaff, M.D., director of the Introduction to Clinical Medicine Program, says a key element to the new curriculum is reinforcement of the need to be an empathetic listener and the need to apply ethical decision-making skills.
To that end, changes in the program include weekly small group sessions of six students with two faculty mentors. Together, they discuss medical dilemmas and challenges posed by actual cases. Students offer their opinions about how they would approach the problem-and then learn how it was actually handled.
For example, one group recently discussed the issues concerning a female patient who sought elective surgery but whose religious beliefs dictated that no blood transfusion be used in her treatment. The wide-ranging discussion session covered treatment alternatives, counseling the patient about risk and respect for her beliefs and rights.
Quinn says that the changes in curriculum formalize a trend toward training more compassionate physicians that was already underway at the Keck School in 1993, when school officials created the Baccalaureate/M.D. program, a program designed to encourage students to broaden their experience and education by coupling a degree in the humanities with their medical studies.
"The idea was that in addition to having students who were strong in the sciences, they would have the broad liberal arts education and strong communication skills that are necessary for the medical profession," she says.
Today, that philosophy factors into the medical school's general application process as well. Admissions officials look for applicants who demonstrate a genuine enthusiasm for helping others-along with traditional academic achievement measures.
Extracurricular events also contribute to the goal of nurturing compassionate physicians.
For example, Keck School instructors have taken their medical students to performances of the play Wit, which details the final months of the fictional life of Vivian Bearing, a scholar of 17th century literature. The professor faces excruciating experimental chemotherapy under the eyes of two research-driven doctors who seem to care more about their study results than Bearing's end result. (One of them describes bedside manner as a "waste of time for researchers.")
Schaff says that medical students gained a better understanding "of the gaps between how doctors perceive their own words and actions and how they may be perceived by the patient. That crystallized a main lesson that we try to teach."
Another resource available to help improve training of both medical students and veteran physicians is the USC/Norris Comprehensive Cancer Center's Cancer Survivorship Advisory Council, a group of cancer survivors and caregivers whose unique perspective helps caregivers and scientists stay focused on the needs of patients.
Diana Chingos, a breast cancer survivor and chair of the Advisory Council, says members serve on committees that influence research, treatment and education decisions throughout the cancer center. They also assist in the design of clinical trials, informed consent agreements and hospital and research policies with respect to medical privacy, ethics and patient issues.
A Topanga resident and television producer, Chingos says that the Advisory Council is important because it helps remind physicians that the process of treatment-especially for patients with serious illnesses such as cancer-can be intimidating and that effective communication can help alleviate fear.
"You may love your doctor and trust them, but as fond as we are of them, we often hear the same problems over and over: that sometimes they speak in jargon or use language that's too complex. That only increases the intimidation factor," she says.
To help keep young physicians mindful of that, Advisory Council members meet with third-year medical students during their surgery rotation to help train them on delivering bad news to patients.
"Our goal is to get to these young doctors before they develop habits that could inadvertently hurt patients or their families," Chingos says.
Quinn says that the Keck School's efforts to emphasize compassion is not just a feel-good approach to treatment, but one that studies consistently show actually hastens the healing process.
"When people believe in their physician, when they understand the treatment process, they get better faster. When people feel that no one really cares about them, it takes longer and there's often less of a desire for following through with taking medications or seeking additional treatment," she says.
The point is that listening matters, Schaff adds. "And the best physicians are the ones who truly listen."
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