April 2000 Bulletin

Good, bad, ugly communication on tape

AAOS uses real interviews to show how to be effective

If it weren’t for all those jets flying overhead—and the snow on the ground—you just might have mistaken the Orthopaedic Learning Center (OLC) in Rosemont, Ill., for a Hollywood studio.

For one day in early February, the OLC was transformed into a TV studio—complete with hot lights, a stage set, camera crew, boom microphone, three actors and a director calling out "Over the shoulder doctor, scene three, take six. Action."

The professional actors, crew, and director gathered at the OLC on Feb. 4 to tape a patient-physician communication video for use in an instructional course at the AAOS Annual Meeting in March. Howard Mevis, director of the AAOS department of electronic media, evaluations and course operations, directed the video.

The taping proceeded smoothly until a change in the weather altered the flight pattern at O’Hare, resulting in numerous orders to "Cut!" and more than a little frustration on the set.

In spite of the uncooperative jets, a few loud trucks, and the need to repeatedly powder the head of the balding "doctor," the taping was successfully completed by late afternoon.

The video was produced for use in a two-hour course, "Communicating With Our Patients: How to Make it Effective and Efficient," that was taught at the Annual Meeting by Wendy Levinson, MD, a patient-physician communication expert and a professor of medicine at the University of Chicago.

In one of her major studies, Dr. Levinson audiotaped 125 physicians (more than half were surgeons) in their offices, each interacting with 10 patients. The three videotaped vignettes were based on the audiotapes.

Two of the scenes involved the communication between a doctor and a middle-aged female patient with carpal tunnel syndrome. One version of this interaction provides an example of "good" communication, while the other version illustrates communication "lacking in empathy."

"The scene illustrating the ‘good’ communication techniques is not significantly longer than the scene with the mistakes," Dr. Levinson points out. "We want doctors to realize that good communication is not necessarily more time-consuming."

For the third scene, in which an orthopaedist behaves in a condescending and insensitive manner while interviewing an older, overweight gentleman who needs a knee replacement, one of Dr. Levinson’s audiotaped transcripts was used verbatim. In the scene, the orthopaedist repeatedly interrupts the patient and speaks in a very sharp, abrupt tone. At one point, instead of praising the patient for having recently lost 35 pounds, he remarks in astonishment, "You mean you used to weigh over 270 pounds?"

"The vignettes are used as trigger tapes, to stimulate discussion," Dr. Levinson says. "The doctors watch the video and evaluate his communication style. It’s very helpful to have a verbatim transcript from an actual patient-physician interaction such as this one. In some cases, the doctor’s behavior appears so extreme, the viewers think it’s been exaggerated for effect. When they find out it’s real, they take notice."

Dr. Levinson is impressed by the emphasis the Academy is placing on effective patient-physician communication.

"It’s pretty novel for a physicians’ or surgeons’ association to place this topic as a high priority," she says. "And I know that the Academy’s incoming president is strongly behind the effort as well. That’s encouraging to see."

Improving the patient-physician relationship is a key initiative of the AAOS Board of Directors. The production of this videotape is just one element of an overall educational program the Academy is developing to help members and residents learn effective methods to improve communication skills with their patients.

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