When one of my duties was handling complaints about clinicians in our managed care network, I got the most complaints about psychiatrists. Sorry, docs, but it wasn’t because they thought you were projecting thoughts into their toasters. The biggest piece of the pie was problems with appropriate communication. These tended to boil down to neglect of what most folks would consider to be the basic stuff of humanity.

This is not a dig at psychiatrists, but a call for action — and a shout out to irony. We know that a lot of our really bright folks tend to have some autistic traits. This can lead to a lot of communication problems. On the other hand, this population can learn a lot of communication skills when things are systematized for them.

But can you analyse empathy enough to actually train on it? Can someone be a better clinician by learning how to act empathic, even if they don’t personally change their sentiments? Wait. That last question might come to mind easily, but it might be missing the point. After all, most doctors, including the poor communicators, are committed to improving their patient’s lives. Inside, they care. So the question isn’t whether they should change on the inside, but how to train them to get better outcomes through objectives such as compliance with the agreed-upon treatment regimine, improved mood, improved relationship support, and improved motivation.

Even the most analytical, poor-eye-contact, forget-to-discuss-side-effects, don’t-discuss-feelings-like-a-normal-person doctor can be motivated by the above outcome objectives and the vision of empathy revealed as a set of finite, reproducable skills.

OK, I know this isn’t a new idea, but now there’s a DVD for that. Duke University researchers have been taking a multi-dimensional approach with a software tutorial plus feedback on recorded sessions with actual patients. The program takes a page from expensive courses that involve role play with actors taking on the role of patient.

So far, the research was with 48 cancer doctors. One of the striking outcomes of the promising study was that patients expressed more trust in the physicians that had used the program.

Now Teach the Patients

But what about reversing the training? Have a course for patients and their support people on how to deal with doctors on the autism spectrum. I think this could be huge. I nominate Temple Grandin to help develop such a course, called, You Doctor isn’t Erie, Just Gifted in Other Ways. OK, scratch that title.

Temple Grandin, the famously autistic engineer has already made a cause of helping people understand how to relate to everyone from developmentally disabled people with autism, to professionals with some autistic traits. She says many are engineers like her. NPR did a wonderful piece on her as well. Excellent, relevant YouTube vids: My Experience with Autism and the TED presentation: Temple Grandin: The World Needs All Kinds of Minds.

One of the things therapists have to do is to help their clients understand and benefit from their psychiatrists. Often, it’s as simple as telling them things the psychiatrist neglected to explain. Sometimes it’s about helping them cope with unusual behavior or actually get a different doc. In many geographic areas, there is a shortage of psychiatrists, so I’m actually more serious about the need than you might think.

Disclosure

The materials didn’t bring up autism, and there are plenty of reasons other than autism that could lead to communication problems.

References

Tulsky JA, Arnold RM, Alexander SC, Olsen MK, Jeffreys AS, Rodriguez KL, Skinner CS, Farrell D, Abernethy AP, & Pollak KI (2011). Enhancing communication between oncologists and patients with a computer-based training program: a randomized trial. Annals of internal medicine, 155 (9), 593-601 PMID: 22041948

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