"At least you don't have cancer."
"What?"
"At least you don't have cancer."
"Noooooo," we groaned in unison as we watched our friend and colleague make another horrible gaffe.
That same friend and colleague put his head down on his desk in shame as the video of him talking to a pretend patient with diabetes continued to play.
The pretend patient spoke, "I'm just so bummed. I can't eat pizza...soda...all the foods I love!"
And once again, our friend replied with, "It's not so bad."
The teacher shut off the video and we began to critique our friend's performance. Was he attentive? Compassionate? Did he support his patient? What could he have done differently?
It was 1994, and we were first-year students at Emory University's graduate program in physical therapy. We were taking a mandatory class entitled Interpersonal Communications. When we first heard about the class, we were both amused and annoyed. Really? They thought we needed to learn how to interact with people? We'd already earned admission into the graduate program, not just by grades but by personal recommendations, work with people, and a series of tests similar to the Myers Briggs Personality tests. Clearly, we knew how to talk to our patients. Or did we?
The director of our program, Dr. Pam Catlin, was short in stature but strong in power. At five feet tall, she strode the halls of the school, heels clicking, blazer buttoned. She presided over our class of graduate students with absolute intensity. We were not allowed to wear casual clothes to class, even though we were young and in the heat of the South. The women wore dress pants, skirts, and (gasp!) nylons (aka pantyhose). No sleeveless shirts or dresses. No open-toed shoes. We were like some crazy throwback to the 1950's. We knew this interpersonal class must be one of her "old-fashioned" ideas.
On the first day, we found out what the class entailed. "Patients" (second-year students) acted out various scenarios between a therapist and a patient in front of our class. We gave feedback on how we thought the therapist acted. We brainstormed ways to make a patient feel attended to and cared for: making eye contact, sitting at his/her level, speaking in layman's terms, etc.
The next class was nerve-wracking, if only for our acting abilities. Each of us went into a private room and met with a "patient" who began to report his/her problems. Our teacher recorded our reaction and conversation with the patient as a baseline to measure our interpersonal skills at the start of the program.
For the next three months, we acted out different scenarios and talked about the importance of rapport. We did not know that we would have a final test on these very interactions. During the last week of class, she filmed us in one last patient-therapist interaction.
So as not to humiliate us because, really, many of our interviews were cringe-inducing, our teacher asked for volunteers to show their tapes. In this way, we were at least willing participants and good sports in the public ribbing that followed. She played the volunteers' first tapes of the year and then their final tapes. The difference was astounding. We had come a long, long way.
I have to say, after all these years, I don't remember all the innervations or genetic mutations I had to memorize. But, on many occasions, I find myself remembering exactly what happened in that classroom and just how important it is to be present with our patients. Maybe some of those skills would have come with time or from having had been a patient myself but maybe not and now those videos are burned in my brain.
Over the years, I have been extremely fortunate to be treated by amazing doctors, nurses, therapists, and assistants. But I have encountered a number of doctors, nurses, and receptionists who I've wanted to enroll in that class. People who've dismissed me. Looked away. Not listened. And I've heard horrifying stories from friends who've been treated callously in the midst of tragedies.
Obviously, caregivers don't mean to be dismissive. I think there's something instinctual that makes us uncomfortable with silence or when we don't know what to say to someone who's suffering. It's then that we often come up with platitudes, sayings about how things could be worse or reminders about how lucky the person should feel.
Then there's carelessness. There are days when we are busy and overwhelmed. We forget to be present. We check our watch. We look away. But what does that say to the person who's scared to death of her new cancer diagnosis or hurting from chronic pain? Although we can't always solve others' problems, connecting by truly listening might be the difference between them leaving with hope or going to their car and crying.
I wondered if, now that the director of my PT school had retired, the school still requires this course. I looked it up online and smiled:
Course Title: Interpersonal Communications
Course Number: DPT 725
Credit Hours: 2 credit hours
Course Catalog Description:
Listening, as well as talking, are skills inherent to providing the best patient care. This course fosters the development of skills in the interpersonal and problem-solving processes.
Pam's legacy lives on.
Although we all can't take a graduate course in communicating, we can take a minute to picture how we'd feel if we saw our interactions on video. Would you put your head down on your desk in shame? Or would you feel proud to see yourself on screen in front of your friends?
