Northwestern Medicine

Communication Training Provides Healing Touch

Northwestern Memorial Hospital July 11, 2011

Workshops equip medical students with ‘toolbox of phrases’ for delivering tough news to patients

CHICAGO, IL – Northwestern Memorial Hospital physician Eytan Szmuilowicz, MD, remembers the first time he had to tell a patient they were dying. The test results indicated end stage lymphoma, and Szmuilowicz, who was a resident at the time, let youth and nerves overpower his delivery of the news. “I just blurted out information to this man about his disease, and then I didn't know how to handle it when he started crying and wondered ‘why me,’” said Szmuilowicz, now a palliative care specialist at Northwestern Memorial Hospital.

“I was so uncomfortable with the situation that I wasn’t able to be the doctor he deserved; someone who could take care of him medically, but also listen and be there for him emotionally.”

Motivated by that experience, Szmuilowicz aspired to improve how physicians communicate challenging news to patients. In 2010, Szmuilowicz developed communication training workshops for medical residents, interns, and students to educate them on the importance of communication when discussing a patient’s prognosis, treatment options or delivering bad news. Today, communicating with a patient is taught as a procedure and is emphasized throughout the Northwestern University Feinberg School of Medicine’s medical school curriculum. The training prepares the staff to feel more comfortable, enabling them to meet patients’ emotional needs throughout the course of medical treatment.

“It’s very easy to run another test, but it can be difficult to just be present with patients in conversation,” said Szmuilowicz who is an internal medicine physician at Northwestern Memorial Hospital. “I want to teach medical professionals how to put their own fears and hesitation about death and dying aside and focus on listening to the patient while providing them with comfort.”

The Department of Medicine communication “boot camp” provides an opportunity for students to learn communication in a similar fashion to learning CPR or inserting an intravenous line. The course trains students planning a career in internal medicine as they approach graduation so they are equipped to begin direct patient care not only at Northwestern Memorial, but at hospitals across the country.

“Sometimes patients just need to talk, but no one’s really listening or they don’t know what to look for,” said Jamie Von Roenn, MD, oncologist and medical director of the Palliative Care and Home Hospice Program at Northwestern Memorial Hospital. “A patient might not always say flat out that they’d like to discuss an issue, so these workshops help identify the variety of cues patients and their families are giving us all the time.” Von Roenn added that cues could be subtle, like a patient’s monotone or apathetic tone of voice.

Von Roenn said that when doctors miss or are dismissive of a patient’s concerns, or focus solely on the medical treatment rather than the emotional issues at play, a patient can feel abandoned.

“Our patients are already in a vulnerable state because this is a highly emotional, highly stressful time for them,” said Von Roenn who is also a professor of medicine at Feinberg School of Medicine and member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “We need to be both doctor and supporter, and help ensure the patient is receiving the most appropriate care based on their emotional and physical cues.”

Each workshop, which is made possible through funding by the Prince Charitable Trust and Northwestern Memorial, along with the physician volunteerism from the Northwestern Medicine Department of Medicine, begins with a discussion on various end-of-life conversations. The discussion utilizes an actor to stage a scene which conveys a challenging conversation, such as giving a young woman a terminal diagnosis or discussing treatment options with a single parent. The actor then participates in a role play with a doctor to show the students how the conversation might play out.

Kathy Johnson-Neely, MD, palliative care physician and chair of Northwestern Memorial Hospital's ethics committee has done amateur acting outside of work; she delivered a performance during a recent training session in which she reported devastating test results to the actor who plays a single parent dying from colon cancer.

“Working with a professional actor during this training is remarkable. We want to make sure the situation feels real. As we watch the actor, we all get lost in the moment; students often forget they are watching an actor and believe the scenario playing out is true,” said Neely, also an assistant professor of medicine at Feinberg School of Medicine. “They walk away from their training with an invaluable skill that will play a critical role in their future in medicine and enhance the care they provide to their patients.”

Following the performance, students are engaged in role play with the actor where they explore a difficult or end-of-life conversation. The student does not know what the scenario may be and is videotaped during the appointment so his or her professor can watch and offer tips for improvement. Students are also taught words or phrases they can respond with when a patient relays their fears.

“It’s common for medical professionals to discuss what’s next in terms of treatment instead of taking the time to understand the underlying issue, which can leave a patient feeling frustrated,” said Szmuilowicz, who is also an assistant professor of medicine at the Feinberg School of Medicine. “Nurses and residents should explore a patient’s concerns by saying things like ‘help me understand why you feel this way,’ ‘what’s most important to you’ or ‘I can see why you’d be upset about this,’” added Szmuilowicz.

Caley McIntyre is a recent graduate of Feinberg School of Medicine and participated in the boot camp program. “The actor made everything feel so real. It was a great chance to think about all the issues the patients face during this difficult time,” said McIntyre. “I picked up some great pointers and believe because of the course I am able to perform better at my job while improving the patient experience.”

Szmuilowicz hopes to expand the program to other departments where end-of-life issues might be at play.

“Through strengthening our communication skills, we’re able to provide the best possible care to our patients,” said Szmuilowicz. “The power to heal isn’t only medical. It’s also emotional.”

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