Learning the Language: The Center For Communication In Medicine

By Susan Bush
12:00AM / Wednesday, October 25, 2006

Clinical psychologist Bernard Bandman

Bennington, Vt. - Some might say that psychologist Bernard Bandman and his wife writer Celia Engel Bandman are teaching people to become "bilingual." But their focus isn't honed on a typical foreign language fluency; what the couple believe is that doctors deliver improved care and patients have improved outcomes when each learns to understand the "language" of the other.

"Good Communication Is Good Medicine"

When communication between patient and physician is improved, results are often improved as well, Bernard Bandman said during an Oct. 24 interview at the 160 Benmont Ave.-based Institute of Medical Humanism.

Writer and medical humanist Celia Bandman

"What we know from evidence-based research is there are better decisions based on care," Bandman said. "There are real results. The better communication is, the better the health outcome. Good communication is good medicine."

The Contributions Of Patricia Barr

The institute was founded in 2001 by the Bandman, Engel Bandman and Patricia Barr, a Bennington attorney who became a national healthcare advocate and policy expert after being diagnosed with breast cancer.

Barr was accomplished, articulate, educated and intelligent, yet navigating the language and landscape of serious illness left her feeling overwhelmed and aware that her unique patient perspective - her voice- was being lost in a medical, technical, and clinical shuffle.

"Pat turned her experience to the public arena," said Engel Bandman.

Barr became active within the National Breast Cancer Coalition, which supports grassroots advocacy and education initiatives. She approached a Bennington-based oncologist with a goal of introducing a patient advocate to the region's oncology services.

"And no one could say no to Pat," Engel Bandman said.

When Barr turned to Engel Bandman and asked her to write a job description, Engel Bandman said she did not believe she could accomplish the task.

"I told her 'I don't think it will work because patient advocacy alienates doctors,'" she said.

"No One Knew What To Do With Me"

But there was a belief that a gap existed between doctors, who often speak in technical and complicated terms, and patients, who want to understand what is happening to their bodies but for the most part, are not medical professionals.

Engel Bandman was ultimately asked to participate and help bridge communication gaps, although initially "no one knew what to do with me," she said.

Using the listening skills she relied on as a writer, she interacted with patients, who opened up to Engel Bandman in ways that they did not with their doctors. What she became, Engel Bandman said, is a "medical humanist."

"It came out that many patients did not know or understand their conditions or their treatments, and when I repeated this to doctors, they would say 'I told [the patient] five times,'" Engel Bandman said.

During one visit, although the doctor emphatically stated that the patient was made aware of the medical situation, Engel Bandman asked the physician to review the diagnosis one more time.

"It was very complicated matter, and [the patient] sat there with a blank look on her face," she said. "[The patient] said she got it 'a little bit more', and I asked the doctor to try and explain it again. He did, in a much louder voice, but the language didn't change."

"I turned to the patient and asked if she had one question to ask, what would it be," Engel Bandman said. "She said 'Am I going to live or die?'"

Stamp Of Approval

Those first conversations evolved into creation of the institute and a three-year pilot project in cooperation with the Southern Vermont Cancer Center. The response from many in the medical community has been strong; in 2002, Bandman, Engel Bandman, and Barr wrote "The Medical Humanist: A Pilot Program In A Cancer Setting," which was presented at Oxford University and published in "Making Sense of Health, Illness, and Disease."

The center founders [Barr died in 2003] have been asked to speak at Brown University Medical School and the University of Vermont College of Medicine and at national and international medical conferences. During 2004, Engel Bandman's "On Medical Humanism" writing was published in the Journal of Supportive Oncology.

This year, the institute introduced the Center for Communication in Medicine. The center develops and offers programs for the medical community and the general public that focus on physician/patient communication and ways that each can better understand the other. A physician education program developed at the center has earned approval from the University of Vermont College of Medicine.

"That is very exciting and it's a major stamp of approval for the work we are producing," said Bandman.

The Lived World Of Illness

As part of the pilot project, a film titled "Voices From The Lived World Of Illness" explored patient and communication issues in the words of four advanced-stage cancer patients.

Barr was among the film participants. Adrienne Barnes, Pete Johnson and George Lewis joined her during the discussion. Lewis is the only surviving film participant.

The film has been shown at Massachusetts General Hospital, Dartmouth Medical School, St. Vincent's Cancer Center and the Long Island Jewish Medical Center.

During the film, Barr described a constantly shifting sense of self.

"I know that now, I don't know who I am," she said, and noted that while she often felt "fine," she was faced with the knowledge that cancer was inside her body.

"It is a constant no man's land."

Barnes recalled the way she learned she had cancer.

"[The doctor] called me at work, while I was on the phone, and said 'you have cancer,'" she said.

Communication and understanding were issues, said Barnes, Barr, and Johnson.

"[Acquiring]A translator, I thought about it," Johnson said in the film.

Physicians must realize that each patient is an individual and that individuality must be acknowledged and validated during the course of illness and treatment. Physicians need to learn "who is the person on the other side," Barr said.

"[Since being diagnosed] I've developed a sense of emotional rockiness I cannot begin to convey," Barr said during the film.

Three Minutes

"Medical humanists" can aid patients and physicians alike, said Bandman.

"Doctors want to give good care, it's why they went into medicine," Bandman said, and added that in most cases, effective communication can occur in as little as three additional minutes.

"Patients want to understand and have valid information, be participants in their care. People need to know how to communicate with their doctors, how it can affect their care. Doctors are beginning to recognize that this is valuable. Our work is on both sides. Our work is on medical information and community education."

Communication center programs include community education, medical education, a program for doctors and nurses titled "The Conversation Hour," a "Writing Is Good Medicine" program, and a "Medical Humanist Communication Model" program that focuses on Engel Bandman's pilot project experiences.

Additional information about the IMH and the Center for Communication In Medicine is available at a www.CommunicationInMedicine.org Internet web site or by calling 802-442-5800.

Susan Bush may be reached via e-mail at suebush@iberkshires.com or at 802-823-9367.