Kealy Ham shook her head and fidgeted, trying to convey an emotion that the circle of people around her would guess, but nobody was getting it.
"Frustrated?" someone finally blurted out.
"Yes!" she shouted, and meant it.
It was an illustrative moment for Dr. Ham and the group — all physicians and health care providers who gathered Monday to learn how training in improv could improve their communication with patients and bring more joy to their work. The training exercise was the first co-created by HealthPartners and the Brave New Workshop comedy theater, but it is part of a national movement in response to studies showing that poor communication is worsening everything from doctor burnout to misdiagnosis.
"Our mission has been to ... breathe life back into the work we do," said Dr. Ankit Mehta, a hospitalist at HealthPartners' Regions Hospital in St. Paul, who co-created the training.
Mayo Clinic surveys have found that as many as half of working doctors are emotionally exhausted or have other symptoms of burnout, which can cause them to quit at a time when the nation already has a physician shortage — or to depersonalize their work and to treat patients like widgets. While improv training might seem like an unusual Band-Aid, Mehta said there are similarities between impromptu skits and doctor-patient visits.
"Improv by nature involves ... actors who get on stage and, in the moment, in a very extemporaneous way, they create a dialogue," he said. "If you look at physician-patient encounters, they're all improvised to a certain degree."
Improv also emphasizes listening, which can be a problem for doctors — one study found that doctors interrupt patients, on average, in 11 seconds — and lead to misdiagnosis. Confirmation bias, for example, can occur when doctors ask questions to confirm their hunches and ignore responses that don't conform to their assumptions.
Mehta and his colleagues first tackled the burnout problem with traditional lectures and training three years ago, but realized the value of improv training after taking sessions in Chicago by a Northwestern University professor and Second City comedy club trainer, and in New York at Stony Brook University's Alan Alda Center for Communicating Science.
In the same way that improv partners keep skits going by listening and playing off one another, doctors can learn to really listen to patients — even if they think they've had the same conversations with 100 other patients, said Elizabeth Bojsza, an improv trainer at the Alda center, which was created by the famed "M*A*S*H" actor.
"Improv skills and training can help that health care professional ... remember this is their [patient's] first time, and they don't use the same jargon that I use," she said.
Brave New Workshop has conducted training for thousands of business and medical groups, but owner John Sweeney said this was its first program created in close partnership with doctors for doctors. One goal, he said, was to help them "be comfortable being uncomfortable."
Missing the cues
About 30 doctors and nurses in the session created group stories by each saying one word, and walked in a huddle and were gradually asked to accentuate their unusual strides or gaits or manners.
The exercise in which they tried to guess emotions was helpful, as studies have suggested that doctors miss 60 to 90% of emotional cues in their patients.
If that is true, Ham said, she hopes she is at least closer to 60%. A pulmonary critical care specialist at Regions, the doctor took the improv training because she said verbal and emotional communications are critical in intensive care situations when relatives of severely ill or dying patients need to trust her.
"Especially in the ICU," she said, "if you lose trust, it's a horrible experience for everyone."
Mehta first tried improv training earlier this spring on medical students rotating through Regions. Dr. Anna Baumgartner, who at the time was in her final year of training at the University of Minnesota Medical School, was skeptical. But seeing how poorly doctors guessed their own emotions made her realize what she might be missing in her patients.
"The person giving the emotions thought she was being so clear and the person trying to read it had no idea," she said, "And I thought, 'Oh my gosh, I might be missing this!' You don't want to miss those things when your patients have strong emotions."
A common concern for doctors is that detailed listening and improv techniques will slow them down as they speed through 20-minute office visits with patients, said Katie Watson, the Northwestern trainer. In the end, she said, doctors not only feel happier when they really connect with their patients, but they also save time because their conversations are more on point.
"Emotional presence can ultimately save time, though that's not the goal," she said, "because you can cut to the chase of what is actually going on."