The annual Department of Physician Assistant Studies symposium focused on medical improvisation, design thinking and empathy.
Empathy in medicine is an essential ingredient in patient communication and care. But to have clinicians – especially training clinicians – agree on exactly what are the features of empathy, and how to recognize and engender them, can be a challenging divide. Indeed, it is the art of medicine. The 5 Annual Department of Physician Assistant Studies Underserved Populations Symposium explored new and innovative ways of understanding and employing empathy.
The foundations for this exploration were laid by Dawan Stanford, director of the Elon design thinking initiative. He challenged students to look at empathy as a healthcare problem that could be fleshed out with basic design thinking: much in the manner in which design thinking was used to develop MRI imaging experiences that were both child- and parent-friendly, and thus empathetic. His presentation initiated a conversation about design thinking and its approaches. It will be the cornerstone of a deeper examination led by Tracey Thurnes, assistant professor of physician assistant studies and assistant director of clinical education, during the PA clinical year curriculum.
Dr. Patrick Wright, a vice president of patient safety at Greensboro-based health system Cone Health, expanded the concept of empathy to include perspectives on population health. He discussed how patterns of disease within Alamance County and surrounding counties are drivers for finance-based health care insurance models – how recent shifts in health care system planning have placed greater emphasis on care of patients, such that they remain low-risk for disease and their entry into high-cost chronic disease is stymied.
Wright reflected on his own upbringing in Kentucky during which his diet (emphasizing a high consumption of simple carbohydrates and fats) caused him to become moderately obese and at significant risk for diabetes; a situation he has since overcome through lifestyle change and allows him to connect with patients facing similar circumstances. Wright led PA students through a design-thinking exercise that demonstrated how the provider’s subjective well-being, needs and perspective influences his ability to experience and engender empathy. He asked, “how might we create a physician assistant experience where self-care is as important as caring for patient?”
Graham Brown, a second-year PA student in the class of 2018, provided perspectives for his colleagues on developing a research project and how clinical training is shaping his professional identity. He is currently working on research that will explore training clinicians’ knowledge, attitudes and behaviors about pre-exposure prophylaxis management.
Dr. Mary Makhlouf, a doctor of dental medicine in private practice in Burlington and a contributor to the development of the DPAS Oral Health Curriculum, provided a penetrating insight into how true empathy entered her life one summer in the late 1980s in Beirut, Lebanon, during that country’s civil war. There, as a member of a volunteer ambulance crew, she was given a choice of two missions: to move children from one of Mother Theresa’s orphanages which was under siege or to recover victims of a parking garage which had partially collapsed.
Shunning the publicity that she thought would accompany Mother Theresa, she chose the latter. In the garage, she encountered a young man, his body badly broken but still alive. In that moment, she told those at the symposium, “there ceased to be enemy and other. No factions, sides, power, struggles or political legitimacy. There became and was only human. And empathy in its fullest form and dress arises when this truth takes hold.”
That same day, she recounted, she learned of a sign, a “poem” as she calls it, displayed on the wall of Mother Theresa’s children‘s home, Shishu Bhavan in Calcutta. The sign was a call and charge to those reading it, reminding them that “such as people are unreasonable, illogical and self-centered, love them anyway.”
After 25 years in her profession, Makhlouf has crafted a vision of empathy which is inspired by Mother Theresa and created exclusively for Elon PA students as a result of her soul-searching and preparation for her talk. She has titled it, “A Clinician’s Field Guide to Empathy.” In it, she reminds Elon students that empathy “is when you recognize that:
- “Some patients are misinformed, in denial, or illogically defend their beliefs… MEET them where they are and gently GUIDE them. Some patients can no longer trust… Be PATIENT with them, go at their pace… Be Diligent, know your LIMITS and DO your HOMEWORK.
- “Some patients just let you do whatever, they’ve given up… GIVE them back their DIGNITY.
- “Some patients will experience hurt at your hands… Be sincere and hasten your APOLOGY.”
The concluding activity of the day-long symposium was a medical improvisation workshop led by Dan Sipp of Duke University and working alongside instructors J Chachula and Brandon Holmes. Together they brought a wide range of experience in acting and improvisation theater. Medical improvisation is intended to bolster better patient-provider communication by fostering more prescient listening skills and seeks to help participants engage the subjectivities of both patient and provider. It deftly brings to the table the issue of context in understanding and communicating – especially the importance of actively engaging with the patient’s narrative and experiences, rather than responding merely to symptoms or to preconceived ideas.
PA students engaged in exercises such as “ Yes… And,” “Take a Bow,” and “Rip Van Winkle,” an exercise in which they have to explain an email or an MRI machine to someone has been asleep for a century.
The University’s 27-month Physician Assistant Studies program is dedicated to engaged learning and delivers a system-based curriculum comprised of hands-on clinical skills labs, simulated patient experiences, patient case scenarios and large and small group learning environments. The program shares facilities with the Doctor of Physical Therapy program in the Francis Center on East Haggard Avenue, home to Elon University’s School of Health Sciences.