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director of communications skills
training at the Henry Ford Health
System.
Dr. Gorosh began the program six
years ago in response to patient satis-
faction surveys and focus groups at
Ford. "Doctors were given feedback if
their scores were low. Most didn't
know they were sub-optimal." She
says. An eight-hour course was creat-
ed, using role-playing, videotapes,
and "shadowing" of doctors (at their
invitation) to help them spot gaps in
their communications skills. Patient
satisfaction scores improved.
Although a few doctors consider
the program akin to "charm school,"
medical leadership and other physi-
cians at Henry Ford are very support-
ive, she says. According to Dr.
Gorosh, medical schools typically
admitted high achievers with strong
scientific ability -- "People skills were
not stressed.
"Science leads to yes/no questions
and a focus on the left brain. Now
physicians need to be experts not
only in information about diseases,
but how to use their health care sys-
tems. Doctors need to set up the
office visit so they hear their patients'
pain and learn about their illness."
Today, younger physicians learn the
importance of communication as part
of their medical education. At Wayne
State University School of Medicine,
students are videotaped to analyze
their communications skills during a
first-year course, "Introduction to the
Patient." A faculty member acts as a
patient and small groups of medical
students discuss the patient-doctor
interaction.
Susan Egley, a faculty member at
Wayne and like Dr. Gorosh, a native
Detroiter and Jewish, believes that
"everyone who cares can be taught to
care through better communications
skills. Physicians are well-meaning,
but it is an emotionally draining pro-
fession."
As an instructor in the Department
of Internal Medicine, Egley works
with students from their first year of
medical school through their residen-
cy. We work on interviewing skills,
reaching the students that they need
to ask open-ended questions. We
show them how to become active lis-
teners, how to explain a diagnosis,
how to communicate bad news and
how to talk with patients when they
are angry or depressed," she explains.
Egley believes that enhanced com-
munication skills lead to greater
patient and physician satisfaction as
well as better adherence to treatment.
Plus, studies indicate that better com-
munication reduces malpractice suits,
Egley notes.
"In almost every case, there is a
communication problem. Patients
understand that mistakes can happen
but they are more likely to consider a
lawsuit if they didn't like the informa-
tion they received or how they got
it, she says.
While physician training is very
important in the communication
process, Dr. Gorosh also urges the
patient to take the initiative. "You're
the expert about your own health. Set
up an agenda for a doctor's visit.
When they get off track, interrupt.
Get books, keep files. Use informa-
tion to crystallize your questions. Be
organized and friendly," she suggests,
stressing the importance of becoming
a "knowledgeable health-care con-
sumer.
Dr. Gorosh believes patients should
be willing to question their doctor's
recommendations. "Let the doctor
know your belief systems. For exam-
ple, if you really object to taking med-
ications, that should be considered.
"If a doctor says, 'You're getting
older and this is what you can
expect,' ask about other options. Ask
the doctor, 'HI was 25 years younger,
what would you think about as a
treatment?'"
She notes that patients often are con-
cerned about offending doctors, who
sometimes get impatient, but people
are entitled to information about their
medical condition. "It's really about
changing a culture," she says.
Dr. Gorosh says her personal com-
mitment to "making, keeping and
nurturing relationships" is the catalyst
for her interest in improving physi-
cian-patient communications. A grad-
uate of University of Michigan
Medical School, she and her husband
have two teenage sons. They are
active members of Temple Kol Ami.
In addition to her medical practice
and teaching within the Henry Ford
Health System, Dr. Gorosh is
involved with the Jewish Federation
of Metropolitan Detroit. El
Notes
Dr. Emanuel Tanay presented a
paper on "The Forgotten Heroes of
the Holocaust" at the conference of
"Children Who Survived the
Holocaust" held in Prague. He is
clinical professor of psychiatry at
Wayne State University.