Making Medicine More Compassionate – Scientific American

By | September 20, 2019

When I was 15, my 21-year-old-brother died of a cancer no one had seen before. His compassionate physician helped us navigate teams of oncologists and wade through his very short journey—three weeks from hospital to grave. My world was shattered. He was my hero. I dove into the one area that could help me navigate my intense emotions and my passion for life: theater. I started professional actor training the next summer, and that decision has taken me from an acting career to a teaching career that now addresses the impacts of caring on patients and their families.

I am the artistic director at the Texas Christian University (TCU) and University of North Texas Health Science Center (UNTHSC) School of Medicine, and our students are a class of 60 future physicians who will one day care for patients like my brother and families like mine. What is the most positive experience you’ve had with a doctor? My collaborative partner, Evonne Kaplan-Liss, and I have asked thousands of workshop participants to tell us their stories. We hear common themes about the doctor listening, taking time to explain what’s going on, checking in after hours, including family in decisions, sharing tears in moments of grief or just being there. Medicine never even makes the list.

That’s not to say medicine can be replaced by kindness—but the things that stick, even when medicine fails, are emotional. We want our doctors to be compassionate. In the midst of rapid changes, with so much technology and medicine to learn, how do you teach compassion? And what does the word compassion even mean?

We think of compassion as empathy plus action. You may walk past a homeless person and feel empathy for his or her life experience. But unless you do something about that feeling, the homeless person has not been treated compassionately. There has been no action. Action could take many forms: a handout, a smile—one guy I know of offers his services to the homeless by giving them free haircuts on the street where they live. Empathy in action is compassion.

You can’t just tell people to be kinder. Deep down, we all think we are kind. Others may judge that assessment as truth or fiction, and in retrospect, we might feel guilty about the things we say or do. But in the moment, we all feel we’re doing a great job in the kindness department. We feel things for others; we do what we can when we can do it—end of story.

Except when it comes to medicine. We always want our health care providers to be compassionate with us when we are traversing the most challenging times of our lives. So how do you teach that? I learned it in drama school.

I’m not saying drama school taught me to be compassionate like my brother’s physician or the man who barbers for the homeless. But I did learn a process through theater training that taught me how to impact an audience. And in turn, this process impacted me. I could imagine myself standing in the shoes others, acting on their dreams and motivations and, ultimately, understanding myself more fully by looking through their eyes. This is the process created by Konstantin Stanislavsky, which is still the primary method of actor training today.

The lessons are not about entertainment—but about listening, connecting, responding flexibly and authentically, adapting, and making creative choices that cause an audience to feel something. Actors can’t depend on talent; we need a process to successfully play through eight performances a week for months or even years. Similarly, doctors need a repeatable process to get through dozens of exam rooms with emotional “audiences.” While technology may advance, the one thing that will remain constant in medicine is feeling.

The most common questions an actor hears after a performance are, first, “How do you learn all those lines?” and, second, “How do you cry on cue?” Memorization is a necessary evil for actors and doctors—and by comparison, actors have it easy. Emotional connection is another story—and although it looks to the audience like this is happening “on cue,” in fact, it changes organically from moment to moment and is deeply tied to technique. “Crying on cue” comes from the actor doing something that creates feeling. Both the actor and the audience experience that feeling—but the technique is a little like the chicken and the egg. Which comes first, the feeling or the action?

Trust me, it may start in rehearsal with an instinctual feeling, but when you have to repeat the moment over and over, the feeling dissipates, and the only reliable way to get back there is through the action. That is the job of the actor. We would contend that understanding and supporting feeling in moments of crisis, elation or sharing bad news is also the job of a doctor.

The most comprehensive research on compassion was recently published in a book called Compassionomics, written by two physicians, Stephen Trzeciak and Anthony Mazzarelli. They point to the “method of deep acting” to the method of “deep acting,”originated by Stanislavsky, as a key to unlocking compassion within the medical community. They also discovered that training in compassion cannot be mandated—the student has to be motivated to learn. Our students have signed on for the challenge and our visionary dean, Stuart Flynn, has defined a mission and encouraged a curriculum to foster both empathy and scholarship.

Who ultimately feels the greater reward, the person who feels sorry for the homeless man or the barber who stops to share his work? The barber has an instinctual talent to know that feeling empathetic isn’t enough—action is required. In theater, talent or feeling alone isn’t enough to repeat a performance. And while medical practice is not a performance, doctors can learn a process to support the emotions of patients and families. Lessons previously only taught in drama school are embedded into our curriculum, called the Compassionate Practice, to help our future physicians understand and enact ways of helping their “audience” feel heard, understood and respected. And just as an actor is transformed by this training process, so, too, will our medical students reap the benefits of their own actions shared with others.

Forty years after my brother’s death. I still remember Renata Engler, the compassionate physician who helped my family through the most devastating weeks of our lives. Engler was a young doctor who had an instinct—a talent—for caring. I contacted her soon after I came to TCU and UNTHSC, and she shared with me that my brother and our family have “stayed with her” throughout her career.

I would contend that the reason behind that effect wasn’t because of what we did for her but because of what she did for us. The goal of our curriculum is to help our students hone their own instinctual talents into a repeatable process, to help them travel through the rewards and complications of the medical system and the personal challenges of a career surrounded by heartache.

Compassion in action goes both ways, providing health to the giver and the receiver.

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