Program helps doctors take unique look at patient interaction

NEWTON — The husband was restless and impatient. As he tried to convince not only his wife, but himself, that nothing was wrong, the message that his heart had an abnormal rhythm was not something he wanted to hear from the hospitalist. Nor did he want to hear the physician’s recommendation that more tests be done.

NEWTON — The husband was restless and impatient. As he tried to convince not only his wife, but himself, that nothing was wrong, the message that his heart had an abnormal rhythm was not something he wanted to hear from the hospitalist. Nor did he want to hear the physician’s recommendation that more tests be done.

“I don’t understand why I have to stay here to do this. Why do I need to stay in the hospital?” the man said, his wife looking worriedly between her husband and the doctor. He didn’t recognize the doctor and didn’t know that a hospitalist was part of a team of physicians who treat patients in the hospital 24 hours a day, seven days a week. He repeatedly demanded to see his family doctor.

In a calm manner, the hospitalist re-assured him that his family doctor, while not present, was involved in his care. “We manage your care in the hospital at your doctor’s request. He knows you’re here. We want to make sure you are safe, that there’s no problem with your heart valve.”

In another room, Dr. Anthony Orsini along with a team of observers from Newton Medical Center, watched this exchange closely on a remote video monitor. The spoken messages as well as hand gestures, body language and other communicative actions were all being analyzed by Orsini and the observers.

A few minutes later, Orsini and the team joined the doctor in the room. The “patient” and his “wife,” who were actually actors, filed out of the room, leaving the doctors to re-live the entire scene on a video screen, sharing suggestions and highlighting moments that truly helped the situation.

This process repeated several times, each time with different scenarios, over the course of two days with the hospitalist and emergency physicians at Newton Medical Center, as part of the “Developing Doctor-Patient Relationships through Better Communication” program, a special training initiative that gives physicians a unique perspective on how they interact with patients.

“By using terms such as, ‘I am concerned,’ rather than ‘I think,’ will make a more personal connection,” Orsini suggested to a few of the doctors, while also complimenting them on their calm demeanors and body language. “Telling a patient that ‘I am your doctor’ instead of ‘we are your doctors,’ helps form a partnership,” he continued.

“Putting your hands on the table as you’re talking to the patient is great, which I think you do naturally,” Orsini said to one doctor. “It’s a great bond.”

Orsini, a neonatologist at Morristown Medical Center, which along with Newton Medical Center, is part of Atlantic Health System, developed the “Breaking Bad News” model of experiential learning more than a decade ago. At that time, Orsini recognized the need to train physicians on how to deliver bad or tragic news to patients and their families. Orsini independently founded the Breaking Bad News Foundation, which is a 501c3 non-profit organization dedicated to promoting programs that teach physicians and healthcare workers how to effectively and compassionately break bad news to patients and their families.

“As a physician, it’s important to have a clear understanding of the patients’ perspective when it comes to the experiences we share with them. That’s not always easy in the moment,” Orsini said. “I developed this project to give physicians the ability to step out of that moment and take a new look at how they interact with their patients, not only to see what they can do better, but also to help them build on their strengths.”

The video work for the Breaking Bad News project is performed by the Bleu Moon Agency, operated by Bob Lukasik and Cheryl Galante.

Paul Owens, MD, chief medical officer for Newton Medical Center, said he saw the program as a good opportunity to enhance the medical staff’s communication skills by providing them with an added perspective on their delivery of care.

“Patients’ perception of the communication they receive is an essential part of the experience,” Owens said. “When they walk out of the hospital and talk to their family and friends, and they remember the doctor who took a few minutes to talk to them, to hear their concerns and their fears, they will remember that. That’s an invaluable opportunity to start the healing process.”

David Stuhlmiller, MD, director of the department of emergency medicine for Newton Medical Center, said the program has helped to further develop the teamwork between Newton Medical Center’s hospitalists and emergency physicians, and said that both groups found the experience extremely informative. He counted himself in that group, having been among the physicians to go through the program.

“In the emergency department, we are usually working with people at an unfortunate time in their lives and we want to communicate with compassion, caring and concern in a way that allows patients and families to understand the medical field,” Stuhlmiller said. “We have to bridge the language of medicine to the language of society. The more practice we get at discussing medical terminology or conditions with patients, the better communicators we will be.”

“Since we don’t see ourselves speak, we may not be aware of our nonverbal communication so this project helps us to be aware of how we look so we can become better communicators, because that’s what our patients and their families deserve,” Stuhlmiller said.

Gina Puglisi, MD, director of Newton Medical Center’s hospitalist program, who both monitored the physicians and went through the program, said that while much of the focus of modern medicine has been on competence in skills and best practices, there has been less of a focus on the compassionate side of care.

“People have less support and less time these days,” Puglisi continued. “I think they’re in more need of someone who can really care for them on both levels, compassionately and competently.”

For more information about the Breaking Bad News program, visit www.bbnfoundation.org or email Orsini at info@BBNFoundation.org.