Saddle Up, Doc!
20. Feb, 2009 
5 Comments
There’s only one thing worse than most doctors’ handwriting. And that would be their bedside manner. After 17 years with a critically, chronically ill daughter, I have learned that some of the world’s most astonishingly bad communicators wear white coats and stethoscopes.
I have personally experienced doctors and surgeons saying the most horrifying things without even bothering to make eye contact. Or telling me part of the story and expecting me to go to the medical library and research the rest as my child is lying there hooked up to life support. Or lying to my face to cover their inappropriate decisions.
The doctor-patient relationship is extremely important. Communication plays a vital part in determining patient outcomes (read: cure or no cure, whether the patient lives or dies). Not surprisingly, a committee overseeing medical licensing exams in the United States has found that poor communication skills are related to a higher incidence of malpractice suits, lower treatment compliance, and decreased patient satisfaction. I’ve met a lot of doctors, and I hate to say that the majority of them disappointed me. But there is hope.
Now there is evidence that horses can help medical students to be better doctors by learning better communication. Yes, you heard right. Working with horses helps some medical students communicate better with patients and their families.“What is even more critical is that, often, what is not said, may still be expressed in other ways. Indeed, the ability to pick up and interpret nonverbal cues that patients provide is with and the ability to, similarly, communicate certain things to patients in the same way separates the true healers from those who are merely adequate.”
Allan J. Hamilton, M.D., a professor at the University of Arizona Health Sciences Center, College of Medicine in Tucson, has a unique method of teaching these skills to medical students–a course called Medicine and Horsemanship: An Introduction to Nonverbal Human Interaction at the Bedside.
Dr. Hamilton emphasizes that working with horses can teach humans a lot about non-verbal communication.
Horses are very magnificently amplified systems of nonverbal communication. Their entire society is built on it. They are hundreds of times more sensitive to body language than we are.
As prey animals, horses’ heightened attention to their environment and to nonverbal cues allow them to serve as mirrors for human body language. In this course, medical students learn what good horsepeople know: To communicate successfully with horses, you have to be acutely aware of your own posture, eye contact, relative position and movement.
The result of completing this course is that students learn more effective nonverbal skills for communicating with human patients.
How?
Every Friday afternoon, a group of medical students dressed in jeans, boots, and hats try to coax horses to leap hurdles or negotiate an obstacle course. Each medical student works with a new horse every week, and they do not use bridles, harnesses, or saddles to control them. Instead, they are taught to use their own body language to gain the horse’s trust and then persuade the animal to perform various tasks.
When I think of it, I have to giggle just a little. It would seem that they are starting from scratch, with no instruction, being asked to move a horse in a certain way, without the advantage of their major communication skill: spoken language. It reminds me of those scenes in the movie 28 Days, where the participants in a drug and alcohol rehab program are asked to lift a horse’s leg. They have no clue how to do it. They have to work it out for themselves. Hilarity ensues, of course. It also reminds me of the way I was taught in the beginning: the trainer sort of threw me into the round pen and watched what I did. Painful. And, in retrospect, funny.
The most important thing these students will learn in this course is this:
Patience, gentleness, and nonverbal communication skills are needed for a good doctor-patient relationship, and the horsemanship course is a dramatic shortcut to learning them. There is no quicker or more effective way to learn about your own body language.
I can only hope that some of the cold-hearted clinicians I’ve had the displeasure to meet will have the opportunity to learn a little about both verbal and nonverbal communication and how it can improve their relationships with their patients (and their parents). I would so dearly love for them to join the ranks of the truly compassionate doctors who worked tirelessly to save my child’s life so many times, yet still had the time, patience and care to speak with me about what they were doing and why. Those were the standouts, the ones I will remember all my life, and that she will remember, too. And to think, horses might have played a part in making them who they are.
Quick shoutout to Peter Heymann, M.D., master negotiator and my hero.
Inspiration for this post came from this article.
blogposts
Really great post – I think I read something about this program.
I have had a few medical issues in my life, and the incompetence in communication has astounded me. I have said before that med students should have to undergo a semester where they do nothing but go to doctors themselves, sit in ERs, be admitted to the hospital, etc. They would learn so much.
The pinnacle of incompetence for me was a doctor who saw me during a post-surgery appt. in which there was a very odd thing going on that needed to be checked out. He did not even bother to ask what the problem was or where it was – he ignored me trying to tell him, looked at the surgical site, and pronounced with great annoyance that there was nothing wrong and I shouldn’t have wasted his time coming in.
I was speechless for a moment, but then he looked at me – the only time he had during that exam – and asked in a snarky voice – is there anything else?
I said, yes, actually, there is. I hope your malpractice insurance is up to date. You can’t imagine the shift in energy that happened next.
As it turned out I had a very rare ‘syndrome’ that he had read about but never seen, and he wanted to parade a slew of medical students in to see it. I allowed him to, but the deal was he had to let me tell the story of his incompetence and why it is so important to talk to the patient, and to listen.
I suppose I should give him credit that he submitted to that and indeed did take responsibility for his behavior, but I still wonder about all the patients who would not have had the gumption to confront him.
Anyway – I hope things are better now for your daughter. I can imagine the advocacy you’ve had to do. It’s so true that having a really GOOD doctor can be such a blessing.
billie
Wow. What a story.
I swear I always thought we were the only ones who weren’t “grateful” to be in the presence of any medical personnel. Of course I’m grateful that the technology and knowledge exists to keep my daughter alive, but the degree to which the patient or the patient’s family has to take control and make it happen still astonishes me. To this day.
The way you handled the situation actually gave me a chuckle. Great nerve! Reminds me of the time I called the pediatric attending from the hospital while he was at the opera to tell him his first year resident was killing my child. He wasn’t pleased, but I was enraged to the point of spontaneous combustion.
I don’t think your doc deserves a lot of credit. You forced his hand. He would never have had to teach his students the lesson if you hadn’t taught him first.
Advocacy is difficult and exhausting. I would so dearly love it if all those haughty med students had to figure out how to get a horse to back up and stop and yield to one side or the other with just his body. HUMBLING. And THEN they should have the ER experience you suggest.
I think a lot of what goes into a good doctor either comes with time or is inborn.
There have been a few who have humbled me and to whom I’m eternally grateful. I wish I could surround myself with them now. We may need them yet.
Nice post and blog! Greets.
Thanks Halle.