Communication Lessons from a TV Doctor

Ever play charades or Pictionary? You get the answer, and start to act or draw it out for your partner. It seems obvious, but your partner can’t guess it. So you just keep repeating the same clues until the time runs out.

That, writes one doctor, is a common issue when talking to patients. He calls it the curse of knowledge. You have all this data and information in your head, but aren’t conveying it in a way that’s easily comprehensible. Maybe you don’t see it from the patient’s point of view. So you’re not on the same wavelength.

What if you could do one thing that guaranteed better outcomes for your patients? This doctor thinks about that a lot. There is a cure-all, he suggests. It ’s not exclusively a medical skill, but the simple act of communicating better: listening, showing empathy, getting the patient’s perspective and ensuring mutual understanding.

That’s what Alan Alda thinks. Okay, he isn’t a real doctor — but he played one on TV. Can a fictional doctor teach you about communicating with patients? He can if it’s Alda, who played Dr. Hawkeye Pierce on M*A*S*H from 1972- 1983. Alda is actually a doctor, of sorts. In 2017, the University of Dundee in the U.K. gave him an honourary Doctor of Laws for his work promoting good communication in science.

Beyond his acting career, Alda advocates for clarity. For 11 years he hosted Scientific American Frontiers on PBS. He’s a visiting professor at the Alan Alda Center for Communicating Science at Stony Brook University (aldacenter.org). The centre has developed a series of programs and workshops taught at medical schools and universities, and have trained over 14,000 scientists and doctors.

Alda wrote a 2017 best- seller called If I Understood You, Would I Have This Look on My Face? about communication in science and life. In 2018, he launched the podcast Clear+Vivid, featuring conversations with guests about how to relate to and communicate with others.

Think of what the patients want and need to know most, and it give it to them first.

In his book, Alda cites a meta-analysis that showed how effective communication with patients improves adherence, satisfaction and even health status. What has he learned about what goes right and wrong in doctor-patient interactions? Here are four valuable lessons gleaned from Alda’s book and podcast.

1. Make listening an action

As an actor, Alda says you don’t say your next line just because it’s in the script. You say it because the other person in the scene behaved in a way that makes you say it. “Real conversation can’t happen if listening is just my waiting for you to finish talking,” he writes.

Understanding that on stage or in front of the camera affects your acting. But he says it’s also a first step in figuring out what has to occur between doctors and patients.

Alda refers to responsive listening. It’s not a passive activity. Unless you’re willing to be changed by the other person talking, you’re probably not really listening. But if you do listen openly — not just to someone else’s words, but their tone of voice and body language too — Alda says “there’s a chance that a true dialogue will take place.”

2. Pace yourself

There’s an improvisation exercise called mirroring. What can it teach about being better communicators? Alda has done it with the scientists. In the exercise, there’s a leader and a follower. The leader has to do a series of slow movements, like stretching an arm or scratching a face. The follower has to mimic it with no delay, so that you can’t even tell the leader from the follower. It’s just like looking into a mirror.

In the beginning, the pairs can have trouble. The follower has a slight lag time. The leader is going too fast. The follower can’t keep up. So the leader has to deliberately slow down. Once the two people have got it, the exercise switches up. Now the follower becomes the leader, and the leader becomes the mirror. Again, they can struggle, but get the hang of it more quickly.

The lesson? The person communicating (the leader) is responsible for how well the other person follows. It’s the follower’s responsibility to catch up; it’s the leader’s responsibility to go slower. Then you can be in sync.

Think of how this applies to not only the pace of information but the nature of it. Are you in danger of overloading your patients at times? Do they want all the detailed facts? Are they able to process them in the moment?

Sometimes, Alda writes, patients “need presence more than knowledge.” He shares the story of an internist who told a patient about her metastatic lung cancer. The patient listened, but didn’t seem to understand. So a medical student along on the rounds asked if he could meet with the patient privately. This student had practised mirroring through the Alda Center. He didn’t use the words metastatic or malignant. He just talked to the patient slowly and simply, holding her hand as she started to cry and ask questions.

“It was the perfect mirror exercise,” the medical student recounted. “I had been leading, then she took over and I followed. Ultimately, what emerged was that I helped her understand death, and she helped me under- stand how to be a better doctor. It was exactly what the mirror exercise is about – that level of connection.”

3. Start at the end

Alda has talked about the work of Dr. Evonne Kaplan-Liss, a former actress who worked as a journalist, then studied medicine and became a pediatrician. She now trains doctors. One anesthesiologist wrote to her and said she had changed her practice because of one piece of advice from Dr. Kaplan-Liss. Don’t start with the details; just get to the bottom line.

The anesthesiologist used to give patients a lengthy description of what they could expect, and felt good about her thoroughness. Now, she begins by saying something like this: “You’re going to be fine. I’m here to keep you safe and comfortable. You’re not going to be in any pain.” Patients visibly relax. Only then does this anesthesiologist get into the specifics.

Think of what patients want and need to know most, and give it to them first. The rest is background.

4. Create a narrative

On Clear + Vivid Alda interviewed Dr. Karl VanDevender, who described his approach to first visits. He has a blackboard in his office, and has patients go through a timeline of their life. Just the act of writing things on the board in their presence shows that you’re listening. Then Dr. VanDevender puts what he’s learned into narrative form. The patient can add to it or change it.

Patients aren’t a series of checklists to mark off, a catalogue of complaints or a set of symptoms. They’re walking narratives. “Everybody has a story. Everybody has a life experience that has texture and meaning to them,” says Alda.