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Can doctors learn from movie directors?

In any consultation involving health professionals there are two ‘actors’ the patient and the health professional. During that meeting each will have something to say and will say it in a specific way. The tone, the emphasis and the volume of their speech will offer information. The actor’s limbs and torso will reflect their thoughts and feelings during the meeting. Their hand gestures and their head movements will betray emotion.

These aspects are not be formally taught at medical school or at least not in the way that actors are taught their craft. And yet how the doctor plays their role in the consult will impact the outcome of that meeting with the patient.

As doctors or health professionals we can’t anticipate how the ‘other’ actor in the meeting will choose to present themselves in the meeting but we can learn to become much more aware of our own behaviour. How we position ourselves, the movements of our limbs, our facial expression, our gestures, our non-verbal response to the information received from the other. In most meetings we have very little time to make an impact in the desired direction and a failure to become self aware will undermine our efforts to be of help.

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Doctoring Warrants A Plan

Most people who attend a family doctor are unlikely to be seriously ill. Many however will benefit from making different choices about how they live because it is now normal to be overweight or obese, it is common to drink too much and take very little exercise. People who attend doctors may have a so-called minor illness which will improve in a matter of a few days without any specific intervention but they will also have many risk factors for long-term illness that would be better addressed now, and certainly before they manifest as diabetes, heart disease, cancer or dementia.

Therefore the aim of the game, if we want to call it that, is to trigger people to make changes in their lifestyle while there is still time. The doctor will be one of the two people in the room when these matters can be in focus. At the doctor’s disposal at that time are five assets; the doctor (or more explicitly the persona of the doctor); the room in which they meet; what they both can see, hear, smell, taste and feel in that space; the actions that can be taken which range from nothing through to a referral to another expert.

Before the interaction the doctor has to have a plan as to how the interaction will unfold. The Art of Doctoring requires close attention to each of the assets at the doctor’s disposal. It is crucial to have considered how these are to be deployed before entering the fray.

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The art of pitching in medicine

If you are a health professional a lot of what you say will be an attempt to pitch to the patient. I forgot to keep that in mind as I broke the news that Hilda had diabetes. Her husband sat bolt upright next to her looking concerned at the mention of ‘diabetes’. I casually asked:

Me: What do you like to eat?

There was silence.

Me: Do you like bread or potatoes?

Him: Yes! She likes lots of bread and potatoes!

Poor Hilda looked like Christmas was cancelled. I knew then that her devoted husband would make sure she didn’t get to enjoy any of her favorite meals and she looked like she just wanted this meeting to end.

A pitch is successful if your ideas get past the Amygdala and through to the neocortex where the information may then be classified as ‘new and interesting’ enough to warrant a second thought. In Hilda’s case the information would simply elicit a flight or fight reaction. When she got home she would argue bitterly that bread and potatoes were not the source of her trouble and that may be she’d prefer to see another doctor. Meanwhile her diabetes would remain problematic. If we don’t pitch effectively we don’t get the best outcomes. For people with coughs and colds we pitch for time, knowing that the symptoms (though horrible) will get completely better. For those like Hilda with a long term illness we pitch for them to make different choices and for those with a life limiting illness we might pitch for surgery and other invasive treatments.

I don’t remember being taught how to ‘pitch’ during my training decades ago. It is often assumed that simply giving people ‘information’ does the trick. But of course our words, when they don’t penetrate to the neocortex, are relayed and potentially reframed by family and friends, or dissected with reference to Dr. Google. That means we fall short repeatedly unless we consider what we say and how we say it in similar circumstances.

Hilda needs her bread and potatoes- I was determined that we would come to a shared understanding of her problem and that the ban would be lifted sometimes. Fortunately in primary care there is that option in most cases. It might also be worth learning the art of pitching from others who do it for a living in three minutes.

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