The Human Touch
Published Jul 1, 2007 8:00 AM
Copyright ©Photo by Ann Johansson
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Dr. Liisa Bergman is frustrated. She's spent the last 20 minutes trying to coax information from Rita Barron, a stylishly dressed patient who has come into Bergman's internal medicine practice complaining of headaches. The large purplish bruises under Barron's left eye, along with an X-ray of her left forearm revealing a "nightstick trauma," a defensive wound common to victims of domestic abuse, make the young doctor fear for her patient's safety. But Barron says her injuries are due to a recent car accident, which no one else witnessed.
"Alright, time out," Bergman finally yells, exasperated. "What do you do when you know your patient is totally lying to you?"
The question's not rhetorical; it's meant for her classmates. If Rita Barron were not really Renee Featherstone, an actor wearing makeup and arm sling, how would Dr. Bergman, a first-year medical student in a Doctoring 1 module on domestic violence at UCLA's David Geffen School of Medicine, ensure her safety? How would she tell the frightened woman she's required by law to report abuse injuries, knowing that Barron's husband is an LAPD detective? Co-instructors Angela Jo M.S. '03, an assistant clinical professor at the Geffen School of Medicine, and Geri-Ann Galanti '72, M.A. '76, Ph.D. '81, a medical anthropologist at California State University, Dominguez Hills, respond that with an evasive patient (Rita Barron is based on a real-life case study), the direct approach may be the only option.
Copyright ©Photo by Ann Johansson
A shaky Bergman nods and looks around the room. She takes a deep breath. "OK, time in," she says, gesturing to her patient. "Rita, I know this can be very hard to talk about … has your husband ever hit you?" No one makes a sound. Tears stream down Barron's face. Bergman reaches for a Kleenex and inches closer. "Sometimes," her patient whispers. "Sometimes."
Past generations called it "bedside manners"; current ones prefer "compassionate medicine." By any description, Liisa Bergman, Andrew Nguyen '05 and Naeemah Logan, who all donned white lab coats to interview the fictional "Rita Barron," are being taught how to bring humanity to a volume-oriented system that's badly in need of it. Susan Edgman-Levitan, executive director at the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital and co-principal investigator of the CAHPS program, which provides widely used patient feedback surveys, insists that "the strongest driver of overall patient care, in any setting, is doctor-patient communication."
In that noble effort, UCLA is ahead of the curve. Almost 20 years ahead.
Standardized patient interviews like the one with "Rita Barron" first appeared in UCLA's medical school curriculum in 1990, as part of an empathy-building concept called Doctoring. The goal was simple: Teach students to rely on interpersonal skills as much as they do on lab reports and CAT scans. The format was revolutionary: Break students up into small teams, led by one physician and one mental health professional, and role-play what doctors really go through in their day; i.e., delivering bad news.