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And the Oscar Goes to . . . Doc Brown?

Acting techniques could help doctors express empathy, physician suggests

FRIDAY, March 4, 2005 (HealthDay News) -- To kindle feelings of empathy for their patients, physicians should study the same acting techniques practiced by film legends Al Pacino, Robert De Niro and the late Marlon Brando.

But if dredging up genuine feelings of empathy seems impossible, doctors can do the next best thing: fake it.

Either way, behaving in a sensitive manner aids the healing process, according to Dr. Eric B. Larson, director of the Center for Health Studies at Group Health Cooperative in Seattle and lead author of a commentary in this week's issue of the Journal of the American Medical Association.

"You should expect the doctor to express empathetic behavior; it's part of the doctor's job," he said.

Doctors, in general, have long endured a reputation for displaying poor interpersonal skills. Medical schools have responded in recent years by creating courses on how to communicate with patients.

"There's a lot to be done, but there has been progress," said Dr. Jimmie C. Holland, an attending physician in the department of psychiatry and behavioral services at Memorial Sloan-Kettering Cancer Center in New York and author of The Human Side of Cancer.

Academic programs often hire actors to simulate patients in role-playing exercises aimed at improving doctor-patient communications, said Holland, who has studied the psychological, social and behavioral aspects of cancer. Teaching acting methods to doctors, then, is not such a far-fetched idea.

"It's better that you can behave appropriately, even if you don't feel it," she added.

Hunter "Patch" Adams, the doctor famously portrayed by Robin Williams in a 1998 movie by the same name, couldn't disagree more. He bristled at the notion of doctors faking it by acting.

"Doesn't anyone want to actually encourage doctors to be empathetic?" the founder of the Gesundheit! Institute asked. "Why not suggest that maybe doctors need to learn to be compassionate?"

Adams, whose books Gesundheit! and House Calls elaborate on his brand of compassionate care, spends four hours with first-time patients, a far cry from the average office visit.

To help doctors master the softer side of healing, Larson proposes that medical schools teach "deep acting," a technique some actors use to alter their emotional state. Among stage and screen actors, it's known as "method acting," a concept originated by Russian actor and director Constantin Stanislavsky to help actors get into the skin of their characters.

"With deep acting, you try to feel what your patient is feeling; try to use the feeling -- the shared feeling or your knowledge of that person's feeling -- to then drive how you communicate with them," he explained.

Doctors also may use "surface acting" to fake empathy for patients by forging their facial expressions, for example, or changing their posture. While "deep acting" is preferred, any effort to show empathy is better than none at all, Larson reasoned.

Even a simple gesture can make a difference. In the "old days," the most popular obstetrician in Larson's hometown was a man who sat down to light up a cigarette every time he met with a patient.

Patients loved him, Larson said. "They all thought because of that act, he'd spent a lot of time with them," even though he hadn't really, he added.

Today, of course, lighting up during a patient visit would be considered reckless disregard, at best. "The point is, he had a method -- a manner, if you will -- that communicated caring," Larson explained.

By learning deep acting, Larson said, doctors can acquire the skills needed to display empathy. And they can do it in a way that goes beyond superficial mannerisms associated with good bedside manner. That's where the emotional labor comes in, he explained: "It's labor to experience what your patients are experiencing."

Future studies need to look at the effects of using these acting methods on job satisfaction, said Larson. He suspects that physicians who fake empathy without experiencing those feelings may be more susceptible to cynicism and burnout.

Dr. Allan Hamilton, a neurosurgeon at the University of Arizona's Health Science Center, agreed that teaching acting is a good first step.

"On the other hand," Hamilton said, "I would hope that empathy has a different meaning when you're talking about a car rental than when you're talking about a heart transplant."

Physicians ought to be held to a higher standard than service-sector workers, added Hamilton, who uses horses in an elective he teaches on human nonverbal communication.

"I worry about a profession that says, 'You know what, when you're done, we're going to train you to be empathetic,' " he said.

More information

The American Medical Association has tips for communicating with your doctor.

SOURCES: Eric B. Larson, M.D., M.P.H.., director, Center for Health Studies, Group Health Cooperative, Seattle; Jimmie C. Holland, M.D., attending physician, department of psychiatry and behavioral services, Memorial Sloan-Kettering Cancer Center, New York City; Hunter "Patch" Adams, M.D., Gesundheit! Institute, Arlington, Va.; Allan Hamilton, professor and chairman, department of surgery, University of Arizona's Health Sciences Center, Tucson; March 2, 2005, Journal of the American Medical Association
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