How the Alda Center Teaches Empathy in Science, and Medicine (Part 3)

Alda Center

 

ABOUT TEN YEARS AGO IT SEEMED TO ME WE COULD HELP SCIENTISTS COMMUNICATE ABOUT THEIR WORK IN A WAY THAT WAS MORE CLEAR AND VIVID. IF IT WORK, IT COULD HELP SCIENCE THRIVE AND IT COULD HELP OUR COUNTRY THRIVE. AND I HELPED START THE ALDA CENTER FOR COMMUNICATING SCIENCE AT STONY BROOK UNIVERSITY.

IT TURNED OUT THAT THE TOOLS WE USED TOGETTO CLEAR AND VIVID– LIKE IMPROVISATION—WORKED SO WELL THAT BEFORE LONG WE WERE ALSO USING IT TO HELP DOCTORSCOMMUNICATE WITH THEIR PATIENTS, AND WITH ONE ANOTHER.

THERE’S A GROWING NEED FOR BETTER COMMUNICATION IN MEDICINE, SOMETIMES FOR REASONS I FOUND SURPRISING.

SO, I THOUGHT THE BEST WAY TO EXPLORE THAT IN THIS EPISODE – THE LAST OF OUR THREE-PART SERIES ON COMMUNICATION IN MEDICINE – WAS TO TALK WITH LAURA LINDENFELD, THE DIRECTOR OF THE ALDA CENTER AND SUSMITA PATI, THE HEAD OF OUR MEDICAL DIVISION.

THERE’S PROBABLY NO MORE IMPORTANT MOMENT IN OUR LIVES FOR RELATING AND COMMUNICATING THAN THOSE FEW MINUTES WE SPEND IN A DOCTOR’S OFFICE. HERE’S MY CONVERSATION WITH LAURA AND SUSMITA ON THAT CRITICAL MOMENT.

 

Alan:                                          00:00:01               This is great because today we have two doctors with us and two completely different kinds of doctors. Susmita, you’re a pediatrician, right?

Susmita:                                  00:00:10               Yes.

Alan:                                          00:00:11               Laura, you’re a whole other kind of doctor. What kind of doctor are you?

Laura:                                       00:00:15               I’m a doctor of philosophy.

Alan:                                          00:00:18               Oh, well, we need more of that.

Laura:                                       00:00:18               A PhD.

Alan:                                          00:00:20               In communication is it?

Laura:                                       00:00:22               In communication, cultural studies is actually.

Alan:                                          00:00:26               What I really would love to talk to you both about is this whole question of what happens in the doctor’s office that we need to do something about? Doctors want to do something about it, too, because the impression I’m getting more and more is that empathy is not just greasing the rails of a transaction. Empathy is medicine in a way. What’s your experience, Susmita?

Susmita:                                  00:00:26               Yeah, absolutely.

Alan:                                          00:00:55               What do you do as a doctor to promote that idea?

Susmita:                                  00:00:57               Yeah. Well, as a pediatrician, obviously, I’m dealing with children of all different ages, babies who can’t talk all the way through teenagers who really can talk a lot.

Laura:                                       00:01:09               But won’t. I have one.

Susmita:                                  00:01:15               You have to with the parents, obviously, engage them. They’re the ones that the children are relying on, especially when they’re small. The parents need to feel that they can trust you.

Alan:                                          00:01:31               How do you bring that about?

Susmita:                                  00:01:32               You have to make that connection. For us as pediatricians … I’m sure there are pediatricians who will relate to this … talk to the child. When you walk in the room, say hello to the child, remark on the child, have the conversation with the child at a level, of course, appropriate for their age. That’s one way to connect right away. Open-ended questions, those are the kinds of things we’re all trained to do as physicians when we talk with patients.

Alan:                                          00:02:05               Well, I’m not sure I know what you mean by open-ended question.

Susmita:                                  00:02:07               Yeah. Instead of asking, “Do you like this one or that one?” Or, “Are you having a cough?” Tell me what you’re worried about.

Alan:                                          00:02:18               In other words, a question that just doesn’t end in yes or no.

Susmita:                                  00:02:21               Correct.

Alan:                                          00:02:21               But gives them a chance to express themselves, tell you a story.

Susmita:                                  00:02:27               Yeah. Exactly.

Alan:                                          00:02:27               Yeah. That gives them a certain amount of power and standing in the transaction, doesn’t it?

Susmita:                                  00:02:33               Yes, it really does. In fact, it’s called taking a history. History has story as part of its word.

Alan:                                          00:02:39               Taking a history I always experienced, I think, all too often experienced as, “How long have you been coughing?”

Susmita:                                  00:02:49               That’s when the doctor has 20 other patients waiting in the waiting room, and they’re running late.

Alan:                                          00:02:55               What about that? When you’re dealing with a child, do you have to be taking notes on your computer while you’re dealing with a child?

Susmita:                                  00:03:02               Obviously, technology has really changed a lot of what happens in that office. Generally, many physicians will have to be at the computer to do some things while they’re in the room. The art is in figuring out how you’ve maintained the eye contact, the connection, to make sure folks in the room understand you’re listening. You’re not just looking at the computer.

Alan:                                          00:03:29               How much time do you have to spend?

Susmita:                                  00:03:31               It depends. Every type of specialty is different. As pediatricians, we’ve got 15 minutes with each patient. For grown-ups, adults, most of the time they have about a half hour for regular checkups, something like that. Sometimes 45 minutes if they have new patients, things like that. The time pressure is real.

Laura:                                       00:07:41               I’ll tell you, if you need one go to this guy.

Alan:                                          00:07:44               I had about a dozen functional MRIs when I did the science show, the Scientific American Frontiers. They all went okay except I never liked being slid into that cigar tube. But this one time, they were so courteous to me and kind to me as they were slipping me in, for some reason they were especially impressed that I was an actor, that I was well known. So much so that they forgot to give me the little emergency bulb.

Laura:                                       00:08:15               Oh, no.

Alan:                                          00:08:15               Where if you get in trouble, you squeeze the bulb and they pull you out. Right?

Susmita:                                  00:08:15               Yes.

Alan:                                          00:08:19               So you don’t panic in there.

Susmita:                                  00:08:20               Yes, right.

Alan:                                          00:08:22               They slide me in and I think, “They didn’t give me the bulb. Oh, well, I guess that’s okay.” Now I’m in the tube, and they’re busy setting the cameras up in the other room. I accidentally moved my hand and within an inch or two from my face I feel that that’s where the tube is, and I suddenly get a wave of panic that I’m in a casket. I’m not in an MRI machine.

Laura:                                       00:08:50               What did you do?

Alan:                                          00:08:51               Well, they couldn’t hear me. There was no bulb to push. I could see them in the next room fiddling with the camera, so I started waving my legs.

Laura:                                       00:09:00               It’s a different kind of dance.

Alan:                                          00:09:05               Yeah. Finally, one of them looked up and said, “What’s he doing? Maybe we better take him out of there.” Then they-

Laura:                                       00:09:05               Alan Alda’s doing the MRI waltz.

Alan:                                          00:09:05               That’s right.

Susmita:                                  00:09:14               It’s different than the bathroom dance.

Alan:                                          00:09:23               That was an occasion of them actually paying attention to me, but it didn’t go very well.You have to be lucky about even when you make contact with the person.Do you get feedback from families about what they need from you?

Susmita:                                  00:09:23               Yeah.

Alan:                                          00:09:41               Do you change how you deal with them in that regard?

Susmita:                                  00:09:44               Absolutely. That’s the first question I ask certainly when I go in the room, “What are the questions or concerns you have today?” You usually get a little bit of prep work, right? That’s the teamwork, so the medical assistant or the nurse has already asked some of those questions, has maybe taken a blood pressure and measured a pulse and respiratory read and those kinds of things. There might be a short summary of what that patient is worried about. Often times it’s only just a snippet, you know, cough, or a fever for a couple of days, something like that. Then that’s the first question, “What are your concerns? What are your questions?”

Alan:                                          00:10:30               Yeah, and how much do they tell you? Do they just tell you symptoms? Or do you get a little bit of a view of their whole experience in life likely?

Susmita:                                  00:10:38               You usually get more than just the symptoms because you get the whole story, “Okay, well, we were at the playground and there were other kids, and this one was sniffling.” Then, “You can’t keep them apart from each other, and then they were playing. Then I heard that that one had got strep throat and so and then from school, and so that’s what I’m really worried about.”

Alan:                                          00:11:03               Does that help you? Is that more valuable to you than just the symptoms?

Susmita:                                  00:11:07               Absolutely. Hearing the story is what helps me remember the story for sure. We all love stories.

Alan:                                          00:11:15               That’s such an interesting idea, that the doctor needs to remember the story, too, in some kind of context. That helps the doctor, I guess, think of the patient not just as collection of symptoms or organs but as a person in a particular context. That puts you better in touch with the person I would imagine.

Susmita:                                  00:11:37               Absolutely. The data show that you can diagnose almost 85% of issues based on getting the whole story.

Alan:                                          00:11:51               That’s really interesting. Tell me more about that.

Susmita:                                  00:11:55               When we’re taught in medical school how do you take the history, there are seven parameters that you’re supposed to get to. You might imagine, it’s just like a reporter. Who, what, when, where, why, how long, what makes it better, what makes it worse? You want to make sure you cover all those bits. There’s also other things. Let the patient tell you what they have. The mother is always right.

Laura:                                       00:12:24               That’s true though.

Susmita:                                  00:12:25               Oh, yeah, right.

Alan:                                          00:12:29               Yeah. When I was researching the book I wrote about communication, I talked to a couple of doctors who told me what I found to be surprising details about hearing from the patient, which included in a couple of cases the doctors couldn’t figure out what was wrong with the patient. They kept conferring, “Is it this? Is it that?” Finally, one of them said, “Let’s go ask the patient.”

Susmita:                                  00:12:54               That’s right.

Alan:                                          00:12:55               The patient said, “I think I got malaria.” It turned out they were right.

Susmita:                                  00:13:02               Absolutely, getting all the information. The saying is, also, in academic centers, the patient is asked to tell their story multiple times. First the medical student goes in. Then the resident goes in. Then the fellow goes in, and then the attending goes in. Each person gets a little bit more of the story, which sets the attending up to look pretty good in the end, right?

Alan:                                          00:13:28               There’s a lot of communication before the attending comes in.

Susmita:                                  00:13:31               Yeah, absolutely.

Alan:                                          00:13:33               My experience in telling them one after another what’s wrong with me sometimes makes me a little frustrated.

Susmita:                                  00:13:40               Of course.

Laura:                                       00:13:40               Yeah.

Alan:                                          00:13:41               I think, “I just told the other guy this.” You know?

Susmita:                                  00:13:44               Yep.

Alan:                                          00:13:45               Is there a way that can reduce that feeling on my part as the patient by the way the doctor who comes knows and lets me know he knows or she knows that somebody has already asked me these questions?

Susmita:                                  00:13:58               Yeah, yeah. Well, here’s what I usually do. I summarize. “Here’s what I’ve heard. Tell me if I got it right.”

Alan:                                          00:14:06               Yeah, yeah. I remember once I had a shoulder operation. I had heard so many stories about operating on the wrong part of the body.

Laura:                                       00:14:17               Oh, God.

Alan:                                          00:14:19               When I took off my shirt, the doctor saw I had written with a magic marker on my right shoulder, “This one.” On the other shoulder I wrote, ” Not this one.” The look on the doctor’s face was pretty good.

Susmita:                                  00:14:36               That’s great.

Laura:                                       00:14:39               Thank God it wasn’t a colonoscopy.

Susmita:                                  00:14:39               Right.

Alan:                                          00:14:44               Let’s not go there. I know it’s a podcast, but

MUSIC BRIDGE

Alan:                                          00:03:55               Laura, you and I are both experts in this but from a completely different point of view-

Laura:                                       00:04:02               You mean doctors, pediatricians?

Alan:                                          00:04:04               No, we’re experts as patients.

Laura:                                       00:04:06               We are.

Alan:                                          00:04:10               Have you had experiences in your life where you wished that the doctor had made better contact with you?

Laura:                                       00:04:16               I have. I’ve had that experience I think too many of us have had where you go in and the doctor’s busy and doesn’t really get to look at you and doesn’t really listen. The person in me who’s empathic is thinking, ” Just drop the computer for a minute and make eye contact.”It feels like you’re not really in the room together. But I’ve also had really good experiences.

Alan:                                          00:04:38               You had to take an MRI a couple of days ago. How did that go?

Laura:                                       00:04:43               It felt a little like having these headphones on. I had an MRI, and they were great. The company I went to was great. They explained it to me. I knew what was gonna happen. It was actually kind of peaceful, a little loud. But what happened afterwards at the doctor’s office was really remarkable. It was a remarkable experience. I walked in and they take your history, your story. You write it out and you go in. The staff looked at me and they said, “What’s happening for you.” “I have pains, a pain in my neck, like literally, not just figuratively.”

Alan:                                          00:05:24               So it’s not me.

Laura:                                       00:05:25               No, it’s not you. It’s not my husband or my kid. It’s definitely not the dog, so a pain in my neck. It feels funny to say that. The atmosphere in there in the pain doctor’s office was so welcoming. I felt very comfortable with them. I could tell from the intake, the person doing the intake, the staff person, she made great eye contact. She spent time with me. She asked, and I gave her the story. Then by the time the doctor came in I didn’t feel so stressed, so I asked her, “How long have you been working here?” She said, ” Two and a half years.” She said, “I love it here. It’s a great team. I really enjoy coming to work.” I thought, “I can feel that.” By the time the doctor came, we only had that 15 minutes that the doctor gets, but the whole atmosphere was set up so that I felt supported.

Alan:                                          00:06:16               That’s something that we found training scientists, thousands of scientists, that not only does the scientist learn to communicate better with the public, but the teamwork that the scientist experiences in the lab improves. A lot of people think of communication as just how you best say this message you have. But what we work on, and that’s seems to really be to the point, is how people let one another into their consciousness and really have a working relationship that’s smoother because of that. That you were starting to be healed by an empathic approach before you ever met the doctor, because the team was functioning better.

Laura:                                       00:07:02               I could tell the doctor had set it up that way.

Alan:                                          00:07:05               How could you tell that?

Laura:                                       00:07:07               Because he’s in charge, and I know that. I know enough about how medical organizations function to know the doctor drives the culture. It just felt like a really safe space. Then the doctor told me a story about he had his first MRI as a kid because he had headaches. I thought, “Wow. That’s really cool that he is disclosing that to me.” It made me feel even more comfortable, because he’s gonna put a needle in neck and inject something in there, so I better trust him.

Alan:                                          00:07:31               I don’t want to hear any more about this.

Laura:                                       00:07:34               You look a little faint, Alan.

Alan:                                          00:07:36               I can take a needle in the neck. I just can’t hear about it.

MUSIC BRIDGE

 

. Alan:                                                                            This is really kind of interesting. Doctors communicating with patients doesn’t sound like it’s a natural outgrowth of scientists communicating with the public. Yet we made that transition, and it turns out that people communicating with anybody under circumstances, they need to be in touch with the person they’re talking to. They need to regard the person they’re talking to. It sounds so simple-minded. Sometimes when I’m being interviewed about this somebody says, “Well, what’s the one thing we should remember about communication?” I think, “What one thing can I say that captures it?” And I say, “Look at the person you’re talking to. Make eye contact. Take them in. Watch them while you talk to them.” But that applies not only to scientists, but it applies in a big way to doctors and their patients, right?

Susmita:                                  00:15:54               Absolutely.

Laura:                                       00:15:56               Yeah.

Alan:                                          00:15:57               It applies in terms of teamwork. As we said before, the teamwork of scientists in their lab, and the teamwork of doctors in their hospitals is affected positively by paying attention to one another in a deeper way than we usually do. I came across some research … I’d be interested to know, Susmita, if this jives with your experience … that when doctors are regarded by their patients as more empathic, the doctors and the rest of the team tend to be happier people. They seem to have more positive experience at work.

Susmita:                                  00:16:40               Absolutely, absolutely. It makes complete sense. Really the first job in the doctor-patient relationship is to care.

Alan:                                          00:16:47               That’s why it’s called care.

Susmita:                                  00:16:48               That’s right.

Alan:                                          00:16:49               That’s like acting. It’s called act.

Susmita:                                  00:16:52               Right.

Alan:                                          00:16:52               It’s doing something.

Susmita:                                  00:16:54               Right.

Alan:                                          00:16:54               Yeah, so how is that caring not expressed enough and why not? For instance, if this is true, that caring and showing you care, showing you have an empathic stance toward the patient, if that’s so important to the health of the patient, how much time is spent teaching that in medical training?

Susmita:                                  00:17:22               There’s a lot of time nowadays that’s spent on that in medical school.

Alan:                                          00:17:49               What takes you away? What are the factors that keep you from maintaining that contact with the patient as such an important thing to their health? What takes you away from that?

Susmita:                                  00:18:01               There’s so many things that now it’s obviously there’s the reimbursement environment. There’s the regulations. There’s the technology.

Alan:                                          00:18:12               There’s more paperwork and checking things off, isn’t there?

Susmita:                                  00:18:14               Exactly and it’s not valued. The time I spend on a phone call with a patient, that’s not paid for.

Alan:                                          00:18:34               Is there actually more concentration on this in the training? How much more? In the course of a medical education, How many hours might be devoted to this?

Susmita:                                  00:18:46               Oh, a lot. I don’t even know. There’s certainly requirements. Medical students spend time with standardized patients, actors in fact, who are trained to evaluate how they are doing in terms of establishing a rapport, a relationship with the patient, being sensitive to the patient’s needs, cultural competency, all of these sorts of things. Unfortunately, what happens is once you enter residency and go on to be a practitioner, the reality of the environment in which you work doesn’t support that, doesn’t support the time that’s needed to make that connection. You’re in an environment where you have 15 minutes. If you have a patient who comes and says, “I’m really worried about my child’s behavior in school,” that’s gonna take more than 15 minutes to unpack.

Alan:                                          00:18:26               And yet that might be a moment where you have a breakthrough with the patient.

Susmita:                                  00:18:30               Right.

Alan:                                          00:19:30               Yeah, yeah. I remember a workshop I saw that we gave at the Center for Communicating Science a few years ago that was very interesting because we use improvisation a lot. In this particular exercise two medical students were involved. One was playing the part of the doctor. The other was playing the part of a patient. The one playing the part of the patient was essentially doing what you do when you have a standardized patient played by an actor. But in this case because it was improvised, the person playing the patient didn’t just rattle off symptoms, but instead was really playing a three-dimensional patient. What the person playing the doctor got from the patient was not just, “I have a pain here and a pain there.” But, “Why did you just tell me that? Am I in trouble? Am I gonna die?” I don’t know if you get that from the other kind of experience where you don’t use this improv technique.

It gave them both an interesting experience, which was this is what it’s like to be a doctor in this situation, and this is what it’s like to be a patient. To go through the experience of being a patient, I think, is probably really valuable for a doctor. Growing up I’ve heard dozens of stories about how doctors make the worst patients.

Susmita:                                  00:21:14               That’s 100% true.

Laura:                                       00:21:15               You played one of those on TV, too.

Alan:                                          00:21:19               Yeah, right.

Laura:                                       00:21:20               On the Big C. I remember that role.

Alan:                                          00:21:22               On MASH, we had to tell 250 stories, so I had one disease after another after a while. I went blind on one show, so I vicariously saw what it was like to be a patient while trying to be a doctor or play a doctor. But the idea that you can actually walk in somebody else’s shoes through vicarious experiences like this play, it seems to me to be a valuable thing. Laura, as the Director of the Center for Communicating Science, it seems to me you’ve had an immersion process in the value of what improv does for people. How have you seen people changed by that or not?

Laura:                                       00:22:19               No, I think it really changes people. It surprises me every time I do because it’s so powerful, and you may not expect it to be so powerful because it seems like this game and this play, but it’s-

Alan:                                          00:22:33               Yeah, very often there’s laughter in the room, not because anything funny is said, but because spontaneity makes you giggle. Therefore, sometimes people disregard it and devalue it because they think, “Well, if we’re laughing at it, it can’t have a serious effect on us.” Yet, you see that happen. You see them change.

Laura:                                       00:22:53               I think it’s about being present. The more I do this, it’s about being present and willing to be a little vulnerable in the room and to open up. We get that trained out of us. I imagine that happens with doctors when you have how many patients a day, 15 minutes each, and all this paperwork. You got to eat lunch sometime, and then you probably have your own kids and your laundry list and this you have to do and get to the gym, and God knows what else. But being able to focus and be present and open up that little bit of vulnerability in yourself that you need to show your own humanity, we get that trained out of us.

Alan:                                          00:23:29               It must be hard to do 20 times a day with 20 different patients.But learning the habit of connecting to the person that you’re talking to, the person who is the actual patient, I guess that’s easy to forget. I remember going into an examining room with my wife who had the problem and the doctor talked to me, which is pretty common I think. How do you get somebody not to do that?

Laura:                                       00:24:05               Don’t show up with Alan Alda.

Alan:                                          00:24:09               Well, that covers a lot of people, right? But we go in and this is from the patient’s point of view, we go together when one of us has a problem. You do that, too?

Laura:                                       00:24:09               Yes.

Susmita:                                  00:24:09               Yeah.

Alan:                                          00:24:22               Yeah. Because it’s invariable the doctor will give some advice to Arlene or make some observations about her. Or, if I’m the patient, about me. The person taking the notes … We take notes on what the doctor says … when we’re leaving we say, “Look at this. This interesting this note, this thing the doctor said.” The other one says, “When did he say that? I never heard that.”

Susmita:                                  00:24:48               Right.

Alan:                                          00:24:49               We just don’t hear. We go in in this state of anxiety and if we don’t have a partner taking notes and reminding us of what took place, we’re liable not to follow the doctor’s advice.

Susmita:                                  00:25:02               Right, right.

Alan:                                          00:25:03               What is there’s nobody in there taking notes? How do you make sure that the patient’s listening to you?

Susmita:                                  00:25:07               Yeah, well, this is actually where technology can be helpful.

Alan:                                          00:25:10               How is that?

Susmita:                                  00:25:12               Because the systems can give the patient materials when they leave that review the recommendations the doctor has made. The doctor in the room can pick the materials that are appropriate for that diagnosis. Common cold, how do you take care of that? Broken bone, what should you do about that? When to remove the surgical dressing if you’ve had an operation. When to call the doctor.

Alan:                                          00:25:37               This gets printed out and you take it with you.

Susmita:                                  00:25:40               Mm-hmm (affirmative). You can take it with you. More and more the electronic systems-

Laura:                                       00:25:43               Email.

Susmita:                                  00:25:43               … are available in different languages. Of course, paying attention to the literacy level of the material so that they’re at a fifth or fourth grade reading level. All of those kinds of things are available with technology now. Then the patient portal like you’re talking about, so that’s where-

Alan:                                          00:26:00               The particular portal? What’s that?

Susmita:                                  00:26:01               Yeah, so that’s the electronic systems. Basically, it’s a sort of email system that’s private and secure between the physician’s office and the patient so that patients can basically send messages like email messages with questions to the office that are non-urgent obviously, and that the office can respond to either by sending some more materials that they might be able to review at home. Or simply writing the answer. All of those kinds of things in an email message to go back, and that’s in use all the time.

Alan:                                          00:26:41               Excuse me.

Laura:                                       00:26:42               I do that, too.

Alan:                                          00:26:42               Let’s all clear. Graham will cut this out.

Laura:                                       00:26:42               I wasn’t allowed to do that on that one. Have a drink of water, too.

Alan:                                          00:26:47               I’ll take a drink. Okay.

Laura:                                       00:26:51               I can hear Sarah Chase’s voice right now coming in in the ad in between.

Alan:                                          00:26:57               I can imagine that having the ability to printout the advice and the follow-up things can also be something that you put too much stock in. If you’re too busy to connect to the patient and you think, “Here. Here read it.” I’m giving them this piece of paper, “Read this. That’ll take care of it.” Whereas, it’s probably a good idea to say it out loud looking them in the eye in addition to the piece of paper.

Susmita:                                  00:27:31               Yeah, yeah, of course, both. Then also doing it as a team.

Alan:                                          00:27:35               What do you mean?

Susmita:                                  00:27:38               The doctor can say, “I’m gonna have my nurse come in and review how to use your inhaler the right way.” Or, “Let the nurse come in and show you how to take the temperature in the tushy, in the right way.”

Laura:                                       00:27:52               We’re back to the proctologist.

Susmita:                                  00:27:52               I know.

 

AS SUSMITA EXPLORED THE PROBLEMS OF COMMUNICATION IN MEDICINE, SHE BEGAN TO FOCUS NOT JUST PATIENTS, BUT DOCTORS, TOO,ARE AFFECTED.

THE EXTENT OF THIS WAS A SURPRISE TO ME—AND IT MIGHT BE TO YOU. WHEN WE COME BACK…

 

MIDROLL

THIS IS CLEAR AND VIVID—AND NOW BACK TO MY CONVERSATION WITH LAURA LINDENFELD AND SUSMITA PATI.

Alan:                                          00:27:54               Right. We’re talking about pediatric. This is raunchier than I thought it was gonna be. Well, the interesting thing is thatWe’ve been talking on these shows about doctor-patient relationship. We’ve talked a little bit today about the team and the effect it has on the team.But you’re focusing on something that I really wasn’t aware was a really serious problem, which is doctor burnout, physician burnout. It must be a harrowing experience.

I’ve always felt that the responsibility that doctors take over the lives of other people just must be so heavy a burden that I don’t know how they can take it.Now there are more pressures on them. You still have that same burden, but now you have less time with the patient. You have more and more interaction with technology than with the human. The pressure must just tear them apart. That concerns you a lot because we’re now doing immersion workshops where we help doctors deal with that. How do you go about that? How do you help a doctor not burn out?

Susmita:                                  00:29:22               Yeah, well.

Alan:                                          00:29:25               Let’s start earlier. What do you mean by burnout?

Susmita:                                  00:29:27               Yeah, yeah. Well, so burnout, there’s lots of definitions and we could talk about that a lot all day. There’s the most commonly used burnout definition is the Maslach Burnout Inventory definition, which talks about depersonalization, emotional exhaustion.

Alan:                                          00:29:47               Who gets depersonalized? The doctor or the patient?

Susmita:                                  00:29:47               Yeah, the doctor.

Alan:                                          00:29:50               The doctor. What does that mean?

Susmita:                                  00:29:51               Not treating someone like a patient, treating them like a thing.

Alan:                                          00:29:55               Oh, I see. Yeah, yeah.

Susmita:                                  00:29:56               Right? That part and then-

Alan:                                          00:29:57               Because the more you treat them like a person, the more it taxes your own emotional life, right?

Susmita:                                  00:30:03               Yes, yes. But the most eloquent way that I’ve heard it put is burnout is essentially an erosion of the soul. Doctors, nurses, many healthcare professionals went into the profession because they want to help people. That medical school essay that everyone had to write talks about helping people. When you feel like you’re not helping people, you’ve lost the meaning in your work. You feel like you’re not able to do the right thing for your patient. That’s burnout.

Alan:                                          00:30:43               I’ve read with regard to burnout that doctors who are experiencing it begin to feel that they’re not accomplishing anything in life.

Susmita:                                  00:30:43               That’s right.

Alan:                                          00:30:55               That they depressed.

Susmita:                                  00:30:57               Yes.

Alan:                                          00:30:58               Lose a sense of purpose.

Susmita:                                  00:31:00               Yes.

Alan:                                          00:31:02               The number of doctors who would not recommend medicine to their children is shockingly high. What is it roughly?

Susmita:                                  00:31:12               59% by some-

Alan:                                          00:31:12               59%, oh my God.

Laura:                                       00:31:15               It’s terrible.

Susmita:                                  00:31:16               It’s a crisis for the profession, right?

Alan:                                          00:31:18               Yeah.

Susmita:                                  00:31:18               For the future of the workforce.

Alan:                                          00:31:19               Where are new doctors gonna come from?

Susmita:                                  00:31:21               That’s right. Yeah. 59 to 70% if you look at the literature and the studies depending on how the question is asked and what group and all of those kinds of things.

Alan:                                          00:31:31               What do you do about that?

Susmita:                                  00:31:35               What we’re offering, and this was really the inspiration for the new types of curricular that we’re offering now through the Alda Center are around how do we rejuvenate that passion that drove you into going into healthcare, that passion to help people by connecting with your team? Building those team connections, because by connecting with your team you’re all gonna feel better about what you’re doing.

Alan:                                          00:32:06               You’re all in it together.

Susmita:                                  00:32:07               You’re in it together, and you’re much more likely to do the best thing for the patient.

Alan:                                          00:32:15               Its so heartening as a patient, as I said, I do feel that we’re experts in medical care as patients.

Susmita:                                  00:32:24               Sure.

Alan:                                          00:32:26               We’re experts in the experience of being a patient. We don’t know that much about the medicine part. Although more and more and I suppose there’s more and more misinformation, and that’s one of things doctors have to be careful about in how they relate to their patients as well I would imagine. But we need to know that we’re going into an experience where there’s caring that’s gonna take place. We need to know it’s not at the expense of the doctor’s wellbeing because eventually that’s gonna be at our expense.

Laura:                                       00:32:58               It strikes me your question about the value of improv. If we think about a doctor who’s burnout and lost that piece of humanity and maybe feels so raw that they’re afraid to show any vulnerability or they’ll collapse, how improv can reinvigorate you. What do you think about improv for this?

Susmita:                                  00:33:18               Yeah. I think it really works having done it now a lot of times.

Laura:                                       00:33:23               Does it help you?

Susmita:                                  00:33:24               It absolutely helps me. It absolutely helps me.

Alan:                                          00:33:27               Can you remember when you were first facing doing your first session that involved an improv exercise? Did you say to yourself, “What the hell is this?”

Susmita:                                  00:33:38               No. Well, look, I’m a pediatrician. I like to play.

Laura:                                       00:33:41               That’s why I like you so much.

Susmita:                                  00:33:51               It was great. It was really transformative. There’s this saying … I’m not gonna say it as eloquently as she does … Maya Angelou has this saying. She says, “A mind that is stretched by an experience can never return to its original dimensions.”

Alan:                                          00:34:09               Oh, that’s good.

Laura:                                       00:34:10               Oh, that’s beautiful.

Susmita:                                  00:34:11               It is beautiful. She’s our poet laureate, right?

Alan:                                          00:34:13               Yeah, yeah. That’s why we found it to be so valuable. Not to lecture people about empathy, but to put them through experiences that generate empathy. I don’t want to put you on the spot, but can you think of some way in which, because improv has been my life, so I’m really interested in how people have been transformed by it. Everybody I know who was a fellow actor studying improv around the time that I first got into it, everybody was transformed, not just as an actor but as a person. Can you remember any moment that you grew from improv?

Susmita:                                  00:35:02               Well, I can tell you,I think I got rejuvenated. I think I’m connecting much more personally with my patients than I was. I’ve been practicing for more than 20 years now. I think I did my first improv session maybe two years ago, two and half years ago. For me it was really a very much a rejuvenating experience to be able to connect more directly, to really remember when I walk in the room not be so stressed about the computer. Just listen to the story.

Alan:                                          00:35:47               Yeah. How long have you had to deal with the computer?

Susmita:                                  00:35:50               Oh, boy. Let’s see. When I was in medical school we had a little bit of computer work for entering orders in the hospital, medications, things like that.

Alan:                                          00:35:50               But when did it become such an integral part of the exam, the patient examination?

Susmita:                                  00:36:11               Yeah, that for me personally happened about 10 years ago.

Alan:                                          00:36:18               Yeah, so that pressure was building, and the improv work helped soften the risk that you ran of being focused on the computer I guess.

Susmita:                                  00:36:28               Right, right. Yeah. In my role I was in charge of organizing how some of our new offices were gonna be built and configured. When we were doing that one of the first things I said, and this was more than eight years ago, was make sure the computer’s in a spot that the physician can be at the computer and still look at the patient. That led to the rooms being, some of them, designed with an arm so the computer can moved in whichever way is needed as opposed to at a desk which is fixed.

Alan:                                          00:37:05               Instead of having to put your back to the patient. So many friends tell me that they go into an examination and the doctor has his or her back to them during most of the time that they’re in there. If the whole examination is 15 minutes and they’re not looking at you for 12 of those minutes.

Susmita:                                  00:37:05               Right.

Laura:                                       00:37:05               How can you connect?

Susmita:                                  00:37:26               Right.

Alan:                                          00:37:27               Yeah.

Laura:                                       00:37:27               You know what improv does, too? I’m thinking as you’re talking. It makes you want to connect because it makes you curious.

Alan:                                          00:37:35               And it’s fun to connect.

Laura:                                       00:37:37               It is.

Susmita:                                  00:37:37               It is.

Laura:                                       00:37:37               It feels good.

Alan:                                          00:37:38               It’s so weird, isn’t it, that we’re social animals, and yet we look for ways to get away from one another would you say? Except the times when we make it a formality. We’re gonna have a party and we’re all gonna get together. But all during the day, for seven days a week or five days a week, we’re forced to be together. We have to find some way to have teamwork, and that seems like a chore. Whereas, as you say, when we do improv we really love being together. You can’t do it without taking in the other person and in a way dancing with the other person.

Laura:                                       00:38:16               Yeah, it’s like it gives you permission to really explore what’s going on and bring your natural curiosity to the relationship.

Alan:                                          00:38:25               Laura, you were at the University of Maine when you first heard about us?

Laura:                                       00:38:29               Yeah. I was actually studying teams. I was helping large science teams collaborate, and people couldn’t get along. They couldn’t agree over terms. Here you have a $20 million grant, and you can’t everybody on the same page. I thought, “There’s got to be a treatment for this.” I looked around, and I found the Center. It was actually, Alan, before your name was even on it. I bought the idea. I thought, “This makes total sense.”

Susmita:                                  00:38:29               It does.

Laura:                                       00:38:57               That improvisation would help you connect better. As a communication researcher, I understand communication isn’t this perfect thing that we receive. It’s the relationships that we craft. It’s like clay that we mold together that shapes how we experience each other. I saw this and I came down. I brought one of my doctoral students and a good friend of mine, Kathleen Bell, an economist. We came down and we did it, and I was blown away.

Alan:                                          00:39:26               Then not long after you became the Director of the Center.

Laura:                                       00:39:28               Yeah, the rest is history.

Alan:                                          00:39:33               That’s great. You know, you’re describing stuff that it’s like an improvisation, the way the Center has grown and put out pseudopods in directions we didn’t expect. 10 years ago when I was trying to get the Center started … as you say, way before my name got on it … I was trying to just see if we could help scientists communicate better starting with improv and then applying that improv to figuring out the way to distill their message or form a message in the first place. I had no idea we were gonna be working with doctors. Then later we were working with all, you know, it applies every interaction that people do.

Susmita:                                  00:40:23               Yeah. It’s actually, improv is now being used to treat and help some patient groups, for example, children with autism, and doing sociodramatic play exercises to help them improve communication.

Alan:                                          00:40:41               Yeah, I think Matthew Lerner, who I interviewed in my book, is a pioneer in the-

Susmita:                                  00:40:47               Yes.

Laura:                                       00:40:48               We’re collaborating with him for that.

Susmita:                                  00:40:48               Right.

Alan:                                          00:40:49               Yeah, I’m so glad. There’s another example of reaching out in ways we didn’t expect with Uri Alon for instance in Israel, a computational biologist, who is himself an improviser.

Laura:                                       00:41:04               He is a cool guy.

Alan:                                          00:41:04               Here is a scientist in a very abstruse science, and he goes out once a week and improvises. He goes to a birthday party and he says, “Tell me the story of your life.” Then his troop acts out the guy’s life on his birthday.

Laura:                                       00:41:20               It’s so funny.

Alan:                                          00:41:21               It’s so wonderful. Then he applies that in his work. He gets better teamwork from his team because he uses the principles derived from improv.

Laura:                                       00:41:31               You can feel it when you meet him. He gets this little twinkle in his eyes when he talks about his work and his team in improv.

Alan:                                          00:41:39               Isn’t it great how we go around the world now? We’re meeting all these people who are applying this stuff.

Laura:                                       00:41:39               I love it.

Susmita:                                  00:41:45               Yeah. Terrific.

Alan:                                          00:41:45               Again, who knew? I didn’t know it was gonna get to this. It’s really, really great.

Susmita:                                  00:41:53               It is.

Laura:                                       00:41:53               We’re improving.

Alan:                                          00:41:53               It is that. One of the things that improv helps you to do is accept the unexpected, accept the innovative, whether it’s coming up out of the back of your own head, or coming up from a teammate. Wherever it’s coming from, you say, “Well, let’s try that. Let’s see what that’s like.” That’s the improv notion of yes and.

Susmita:                                  00:42:16               Right.

Alan:                                          00:42:17               Right?

Laura:                                       00:42:17               I just had this thought. A lot of people think of improv as you make it up. Really what improv is about is taking what you have and working with it.

Alan:                                          00:42:27               Right, right. Another way I would put it is making things up, which is, as you say, what a lot of people think improv is, that’s invention. But in fact it’s more like discovery. You know?

Susmita:                                  00:42:41               Mm-hmm (affirmative).

Laura:                                       00:42:41               That’s great.

Alan:                                          00:42:42               The guy who found the Pacific Ocean didn’t invent it. He didn’t say, “I’m gonna put an ocean there. I got a great idea.” On the contrary.

Laura:                                       00:42:53               How do you know that?

Alan:                                          00:42:53               I just have this inkling. I think he walked up and saw on the other side of the hill, “Oh, my God, there’s an ocean.” That’s what happens in improv. You say, “Look at the ocean we got here.” Somehow that helps teams work better together because they’re all in it together. It’s partly through this improv technique of yes and. Right?

Susmita:                                  00:43:17               Yeah.

Alan:                                          00:43:19               Uri Alon just says … the guy from Israel … “In an improv, in a scene where you’re acting out a scene, if one of them says, ‘Look at all that water down there,’ and the other one says, ‘That’s not water. That’s the stage,’ then that’s the end of the scene. Where as, if he uses yes and and says, ‘Yes, look at that water,’ and then, ‘Why don’t we jump into it and chase that turtle and see how far we can get?'” That’s how teamwork happens, I think, by yes and-ing each other.

Susmita:                                  00:43:54               Yes.

Alan:                                          00:43:55               How far do you take improv into the actual experience of making a team work better together? What do you do?

Susmita:                                  00:44:06               There’s different ways you can approach it. Certainly, yes and is so critical. It’s a foundational principle. Getting everyone on the same page, being clear who’s doing what. Those sorts of things are certainly founding the basis. Then you have team leaders. Typically, in medicine the physician is viewed as the team leader, certainly is the one who ultimately makes the decisions about what to do with the clinical care.

Alan:                                          00:44:41               But what you’re saying is viewed as the team leader. Do you mean that the real team leader is the nurse?

Susmita:                                  00:44:46               Well, the thing is the nurse is the one who’s closest to the bedside, closet to the patient, and probably knows the patient’s story in the most detail.

Alan:                                          00:45:06               Yeah. We were talking before about humility. I remember that there was such a lack of humility when I was a boy. When I was seven-years-old, I got polio. About a few years earlier Elizabeth Kenny, a nurse in Australia, figured out a treatment for polio. There was such a lack of humility on the part of the doctors she tried to explain her theories to and her treatment to, she was taking people, kids, who were paralyzed and helping them walk again. Such a lack of humility that when she lectured to one group of doctors, while she was talking, they stood up and faced the window, turned their backs to her.

Susmita:                                  00:45:54               Wow.

Alan:                                          00:45:55               That’s extreme, but anecdotally I hear about doctors today, still today, who say, “No, this is what I’m doing. I don’t want to hear from your experience at the patient’s side.” Is that still a problem?

Susmita:                                  00:46:13               I think it probably is in some places. It’s certainly not what’s taught.

Alan:                                          00:46:19               Right.

Susmita:                                  00:46:19               Not any more. However, the team piece, how to work as a team, that’s something that’s just emerging as part of the medical school curriculum. Most physicians out there practicing didn’t learn how to do that. Neither did nurses. Neither did the respiratory therapist or the physical therapist.

Alan:                                          00:46:45               I get the impression that it’s … This is true I think in the corporate environment … not only does the leader need to be able to listen to the person on the organizational chart who’s under them. But the person who is speaking to the leader has to find a way to get in there and get the leader’s attention to really important details that the leader might not be aware of.

Susmita:                                  00:47:14               Yeah. Yeah, there’s some efforts that have been done around building teamwork in healthcare teams. There’s various curricula, team steps, crew resource management. That comes from the airline industry actually. Actually, healthcare teams are great at working together in emergency situations in a code when someone’s dying, because it’s very clear who’s doing what. But most healthcare teams are not handling patients who are in a code emergency situation most of the time. Most of the time you’re handling a lot less emergent issues, and that’s where team communication needs a lot of improvement in order to do the right thing for the patient.

Alan:                                          00:48:07               I’ve always wondered why they say code. I never learned why is the word code used? It sounds so mysterious use of a word.

Susmita:                                  00:48:16               I know. It does, doesn’t it? Well, it’s calling a code, I think, was probably came out of the need, and I’m guessing here. I’m just making up the story here, right?

Alan:                                          00:48:29               Yeah. Good, good.

Susmita:                                  00:48:31               But I’m guessing that when you’re in the hospital and you have lots of sick patients around you-

Alan:                                          00:48:41               Oh, you don’t want to scream out, “This person is dying.”

Susmita:                                  00:48:43               Exactly.

Alan:                                          00:48:47               They used the word code as a code.

Susmita:                                  00:48:48               Code as a code. Now there’s different types. There’s Code Blue. There’s Code H. There’s Code M, all different-

Alan:                                          00:48:56               Is Code Blue where the patient is turning blue or what?

Susmita:                                  00:48:56               Yes.

Alan:                                          00:48:58               Really?

Susmita:                                  00:49:01               Stopped breathing.

Laura:                                       00:49:01               Really?

Alan:                                          00:49:01               Oh, my God.

Susmita:                                  00:49:01               Code Blue is stopped breathing.

Alan:                                          00:49:02               Look it, and we didn’t know, see. But it’s important for these terms not to be understood by us. This is an interesting communication problem where you deliberately are obscure for the health of the person listening.

Susmita:                                  00:49:15               Yeah.

Alan:                                          00:49:17               I never thought of that.

Susmita:                                  00:49:18               Yeah. That used to be the very sort of, for lack of a better word, paternalistic training in medicine.

Laura:                                       00:49:18               Yeah. That’s the word that came to mind.

Susmita:                                  00:49:28               Way back in the ’20s, ’30s, when you had polio, that was the training. Don’t tell the patient they have cancer, because they won’t be able to handle it. That was the philosophy. Obviously, a lot has changed with time.

Alan:                                          00:49:47               Yeah, now the patient comes in and tells the doctor what they got.

Laura:                                       00:49:47               Yeah, right.

Alan:                                          00:49:52               The doctor is lucky if they let them help.

Laura:                                       00:53:02               If you look at the meaning of the word communication, calm with and unity coming together.

Alan:                                          00:53:12               Is that where it comes from, or you’re making that up?

Laura:                                       00:53:20               No. I don’t know. Maybe I made that up. No, it’s where it comes from. Yeah. I remember that much Latin.

Alan:                                          00:53:23               For this they gave you a doctorate.

Laura:                                       00:53:26               In philosophy.

Susmita:                                  00:53:30               Well, also, the literature now about leaders and what people what in leaders.

Laura:                                       00:53:36               That’s fascinating stuff.

Susmita:                                  00:53:37               Yeah. It talks about-

Laura:                                       00:53:40               People when you ask them, “What’s a leader look like?” People will say, “Oh, it’s someone who creates vision.” But when you ask them, “What does a good leader do for you?” The Gallup-

Susmita:                                  00:53:51               Poll.

Laura:                                       00:53:51               The Gallup Poll has four qualities.

Alan:                                          00:53:54               Which says what?

Laura:                                       00:53:54               Let me see if I can get these right.

Alan:                                          00:53:56               Well, make up a couple.

Laura:                                       00:53:57               Leaders inspire … They buy you lunch. No … hope, consistency, trust, and sympathy. That’s what great leaders do for people.

Alan:                                          00:54:10               Whereas a lot of us think of leaders as the guy who gives the orders.

Laura:                                       00:54:10               Exactly.

Alan:                                          00:54:19               Do this or else. What you’re describing instead sounds to be me like a collaborator who has a lot to say because of the job of being the leader but doesn’t dictate.

Susmita:                                  00:54:32               Right. If you think about in history the great leaders you can think of Martin Luther king. You can think of Gandhi. You can think of all kinds of folks. They didn’t get leadership training, right?

Alan:                                          00:54:48               Yeah.

Susmita:                                  00:54:50               But they embody those qualities.

Alan:                                          00:54:53               What about now? You have a leader who’s the head of a medical team. That leader has expert experience and training in a very specific part of the medical-

Susmita:                                  00:55:10               Field. Yeah, yeah.

Alan:                                          00:55:11               … field, so that person expects to be listened to with good reason. Yet, there’s information and there’s guidance he can actually get from other people like nurses. How does that person, how does that leader know that relinquishing the reins sometimes is important?

Susmita:                                  00:55:39               I don’t think all leaders do know that. But the literature shows you to get the best out of your people that you work with keeping those lines of communication open is the best way to get the best quality work.

Alan:                                          00:56:03               That can really pay off I imagine in an emergency situation, during an operation where bleeding goes out of control or something like that. If you’re don’t have a level of teamwork established where you can without going back to basics and starting from scratch and saying, “Look, I see something here. You got to pay attention.” But you have an open channel between all the members of the team, you have a greater chance of life it seems to me.

Susmita:                                  00:56:33               Yeah, absolutely. You want to share the burden. You want to share the burden.

Alan:                                          00:56:41               Yeah, which gets back to burnout a little bit, doesn’t it?

Susmita:                                  00:56:42               Yeah, yeah. Yeah, it really does. I’ve had the privilege of working in multiple places, multiple healthcare systems. I’ve had the privilege of working with teams where in the morning on rounds I went into a patient’s room and I said, “We’re gonna use a feeding tube today. We’re gonna start that. The team’s gonna come and teach you, as the parent, how to use that feeding tube. Or they’ll do x-rays to make sure the tube is in the right place. There will be a lot of teaching,” all of those kinds of things.

Well, by the time I finished rounding for the morning, because the nurse who is taking care of the patient heard that discussion and because we know what we’re trying to do, we’re all on the same page, the tube is already in the patient’s nose. The x-ray’s been done, and they’re at the bedside teaching the parent how to use the equipment in like an hour.

Alan:                                          00:57:47               You were working hand in glove in a way.

Susmita:                                  00:57:47               Hand in glove.

Alan:                                          00:57:50               Yeah, that’s great. I think our time is about up. But this is, off-camera I’m gonna say this. Is there anything that you hoped you wanted to get across that we should get into? Or, Graham, is there any question you have that we should raise?

Graham:                                  00:58:06               [inaudible 00:58:06]. There’s a lot of emphasis on teamwork.

Alan:                                          00:58:15               Yeah.

Graham:                                  00:58:16               You specifically address that question.

Laura:                                       00:58:16               Yes.

Graham:                                  00:58:20               Involving team leaders who have worked with the [inaudible 00:58:21].

Alan:                                          00:58:22               Good. You’re hearing Graham, too?

Susmita:                                  00:58:25               Yes.

Laura:                                       00:58:26               Yeah.

Alan:                                          00:58:26               Yeah, so let me put that as a question.

Laura:                                       00:58:30               Then I could talk a little bit about what we’re doing with science teams.

Alan:                                          00:58:31               Yeah, Good.

Susmita:                                  00:58:32               Yeah, great.

Laura:                                       00:58:32               Because if you remember, there’s a nice chunk of money from the Simons Foundation to do that so.

Alan:                                          00:58:40               Yeah, good. Thank you. I’m so glad that medicine in general isworking on empathy. I know Langone is working on empathy. I see other hospitals and other medical schools are working on developing empathy. It’s wonderful to see because as we’ve been saying in this conversation, it’s a part of healing. It’s interesting that we’ve talked so much about the importance of teamwork. How do you improve teamwork in the workshop that we do?

Susmita:                                  00:59:19               Yeah, so I’ll tell you our experience at Stony Brook. We ran for about a year one and a half hour workshops with healthcare professionals who work with children. It included doctors, nurses, trainees, respiratory therapists, anyone who touched children in the hospital. We did these improv exercises that were designed to rejuvenate their passion for entering healthcare and build connection with each other as the healthcare team.

Now the folks in the room weren’t necessarily assigned to work with each other. They were people who all worked with children, but they didn’t necessarily work together every day. Through the improvisational exercises, they were really working on, again, building that connection and thinking about how to communicate more clearly. We found that in the wake of running those exercises, so we had about 150 people who went through that. The children’s hospital certainly has at least tenfold number of employees, so we didn’t touch everyone. We touched a small group.

The nursing leadership came to us afterward and let us know that, in fact, the nurses were now when they were making perhaps comments that came off as abrupt with each other or disrespectful, things like that, they were signaling to each other a forgiveness for that.

Alan:                                          00:59:19               Wow.

Susmita:                                  01:01:07               By doing a ta-da.

Laura:                                       01:01:09               We have this exercise called clown bow where you learn to get over a mistake really fast and move on and support your partner. We say, “Ta-da,” when you make a mistake and we force you to make a mistake. “Ta-da.” Right, Susmita? Ta-da.

Susmita:                                  01:01:24               Yeah, ta-da.

Laura:                                       01:01:24               What we heard is the nurses are to ta-da-ing in the halls at Stony Brook Medicine.

Alan:                                          01:01:27               Yeah. Yeah, that’s one of my favorite exercises. I’ve told you that I often go through a day making small mistakes, not one where I almost kill somebody, little social mistakes, “I should have said this. I was abrupt about that,” or something. I’ll say to myself, “Ta-da.” You know? Ta-da, and it just goes away. I don’t burden myself. It’s interesting. Your guilt about little things can add up-

Susmita:                                  01:01:27               It does. It does.

Alan:                                          01:01:55               … to a real burden. I can see how in a medical situation that burden can lead to burnout. Did you find that all of this improv application to the medical experience came from how you worked with scientists earlier?

Laura:                                       01:02:13               Yeah, these little things, they add up. First it’s one thing. You beat yourself up. You get angry at your colleague. You don’t say it and it builds up. What happens is distrust, resentment, confusion, people get burnt out. They pull back. What improv does is it brings you back together and helps you say ta-da as a group and see each other’s humanities. We’re starting to do more and more work specifically now on how we can help science and medical teams. It’s the same principles. Create a greater connection with each other as a group as a sense of collective self.

MUSIC BRIDGE

Laura:                                       00:49:54               One of the areas I feel like that’s started to emerge as we move forward with this conception of teams is the relationship of biomedical researchers to physicians. How do you bring the science that you’re doing? If you’re at the bench, how do you bring that to physicians who are also trained as scientists so that they’re willing and accepting of the evidence-bases that you’re creating. I was thinking as you were talking before, Susmita, about a number of biomedical researchers I’ve experienced who have had challenges having doctors listen to them, especially around cancer treatment. “Well, I’m not gonna stop doing it that way, because that’s the way we’ve always done it.” Even though a more personalized approach might make the patient more comfortable and even healthier.

Alan:                                          00:50:45               That we’ve worked with efforts that have really interested me to incorporate the experience and the knowledge of the researchers with the physicians who are delivering medicine and the community that they’re working with who have medical needs. The gap between those three groups sometimes is serious and something that’s not in everybody’s interest.

Laura:                                       00:51:17               It’s creating a bigger sense of who the team is.

Alan:                                          00:51:20               Yeah, oh, good, yeah.

Laura:                                       00:51:21               Right?

Alan:                                          00:51:21               Yeah.

Susmita:                                  00:51:21               Yeah.

Laura:                                       00:51:22               Putting everybody together on your team. I was thinking about your interview with Father Boyle and how he talked about you’ve got to open up this relationship where you’re a person who someone else can come to. I’m phrasing that poorly. But if you think of everybody involved in this system as part of the team together, that proximity breeds trust.

Alan:                                          00:51:46               He said an interesting thing about when somebody comes in for the first time to one of his organizations, it’s very much like what you said, Susmita, before about … what both of you said, you too, Laura … the team welcomes you with an aura of care. He talked about the first minute, the first second you come in the door, you’re in touch with someone who is using tenderness.

Laura:                                       00:52:19               I love that word.

Alan:                                          00:52:19               Yeah. It’s another word for care, I think, another word for connection, for wanting the best for the person that you’re talking to and letting them know that, and not swamping them with your officiality. Look at that works in Boyle’s work in getting gang members free of their gangs and having constructive lives. It works in medicine. It works in pretty much every enterprise in life. To spend conscious effort in helping that come about and not just saying, “We ought to have it,” it seems to me to be the way to approach it.

Alan:                                          01:02:55               So we’ve come to the end of our talk. We always ask seven quick questions hoping to get seven quick answers.

Laura:                                       01:03:04               You go first.

Alan:                                          01:03:08               Okay. There are two of you, so I’m gonna really make this quick.

Susmita:                                  01:03:11               Okay.

Alan:                                          01:03:11               Susmita, what do you wish you really understood?

Susmita:                                  01:03:11               Chinese.

Alan:                                          01:03:19               Chinese. Best answer I had yet. What do you wish other people understood about you?

Susmita:                                  01:03:39               I like to play.

Alan:                                          01:03:43               Good. These are all vaguely related to communication, and this one directly related. What’s the strangest question anyone’s ever asked you?

Susmita:                                  01:03:51               Oh, boy. Are you a nurse?

Alan:                                          01:03:59               Oh, that’s great. That’s great.

Laura:                                       01:04:01               How may times a week do you get asked that?

Alan:                                          01:04:04               Another communication question that’s direct. How do you stop a compulsive talker?

Susmita:                                  01:04:10               Make a joke.

Alan:                                          01:04:12               Oh. Is there anyone you just can’t feel empathy for?

Susmita:                                  01:04:17               Oh. Child abusers.

Alan:                                          01:04:23               Mm-hmm (affirmative). How do you like to deliver bad news? In person, on the phone, or by carrier pigeon?

Susmita:                                  01:04:31               Depends on how much empathy I have for the other person.

Alan:                                          01:04:34               Good enough. Okay, final question. What if anything would make you end a friendship?

Susmita:                                  01:04:47               Betrayal of my trust.

Alan:                                          01:04:50               Okay. Laura’s shaking her head. You’ve got to go through these questions quick, especially if anybody ever asked you if you were a nurse.

Laura:                                       01:04:56               Okay.

Alan:                                          01:05:01               Excuse me. Okay. Laura, first question. What do you wish you really understood?

Laura:                                       01:05:07               I really wish I understood how other people actually feel.

Alan:                                          01:05:11               Oh, oh. What do you wish other people understood about you?

Laura:                                       01:05:15               How much I really care.

Alan:                                          01:05:18               What’s the strangest question anyone’s every asked you?

Laura:                                       01:05:21               Okay, here’s my answer. In 1999 some guy on a date asked me if I wanted to start working on the millennial baby. Is that terrible?

Alan:                                          01:05:33               On a date?

Laura:                                       01:05:34               On a date. That was the last date.

Alan:                                          01:05:36               Well, that’s the best answer I heard to that question. How do you stop a compulsive talker?

Laura:                                       01:05:43               How do you stop a compulsive talker? I think I walk away.

Alan:                                          01:05:46               I’m the compulsive talker.

Laura:                                       01:05:49               I’m still here.

Alan:                                          01:05:49               Do you have a technique?

Laura:                                       01:05:54               I walk away, just try to get out of it.

Alan:                                          01:05:56               Oh, okay. Is there anyone for whom you just can’t feel empathy?

Laura:                                       01:06:01               Yeah.

Alan:                                          01:06:02               You gonna say?

Laura:                                       01:06:03               No. Not on air. It has to be really bad.

Alan:                                          01:06:06               Okay. I got it. I got it. I got it. How do you like to deliver bad news? In person, on the phone, or by carrier pigeon?

Laura:                                       01:06:14               I don’t like to deliver bad news, but if I have to I’d rather do it face-to-face.

Alan:                                          01:06:18               Okay. Last question. What if anything would make you end a friendship?

Laura:                                       01:06:23               Betrayal.

Alan:                                          01:06:24               Yeah, you both were aligned on that. Thank you so much, both of you, for coming in and talking. This has been really fun. I love our teamwork together.

 

CREDITS

This has been Clear + Vivid, at least I hope so.

 

My thanks the sponsors of this episode. All the income from the ads you hear go to the Center for Communicating Science at Stony Brook University. Just by listening to this podcast, you’re contributing to the better communication of science. So, thank you.

 

 

And speaking of the Center for Communicating Science, I can’t thank Dr. Laura Lindenfeld and Dr. Susmita Pati enough for ALL they do, and their tireless effort in helping the Center grow and mature. Laura’s leadership as the Director and Susmita’s contributions for our medical program, are making my dream for better communication a reality – and in big ways.

 

The Alda Center now conducts over 100 workshops around the world each year and we’ve trained more than 12,000 scientists. To find out more about we do and to take part in a workshop, please visit: AldaCenter.org

 

 

This episode was produced by Graham Chedd with help from our associate producer, Sarah Chase. Our sound engineer is Dan Dzula, our Tech Guru is Allison Coston, our publicist is Sarah Hill.

 

You can subscribe to our podcast for free at Apple Podcasts, Stitcher or wherever you listen.

 

For more details about Clear + Vivid, and to sign up for my newsletter, please visit alanalada.com.

 

You can also find us on Facebook and Instagram at “Clear and Vivid” and I’m on Twitter @alanalda.

 

Thanks for listening. Bye bye!