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October 14, 2013 // By Katie Delach // Comments

Out of the Exam Room, and Into the Classroom

Education // Patient Care Share this article

Penn Doctors Spend a Day in Their Patient’s Shoes

If a doctor applies a band-aid with a smile, does a wound heal faster? Maybe not, but in today’s changing health care landscape, health systems, physicians and insurance providers alike are placing more emphasis on patient satisfaction, and recent research suggests that it might not be safe to assume that a healthy patient is a happy patient. According to an article in a recent issue of AAOS Now, the journal of the American Academy of Orthopedic Surgeons, historically, physicians have focused on technique and objective outcomes as measures of ‘patient satisfaction,’ while patients have viewed their satisfaction as a reflection of the physician-patient relationship.

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Autumn Fiester, PhD, director of the Center for Clinical Ethics Mediation, leads a course for Penn faculty and staff on conflict-resolution

Now, in an effort to continue raising the bar on our quality of care and help faculty to refine their leadership and development skills, Penn Medicine’s Center for Clinical Ethics Mediation is providing courses aimed at arming clinicians with the skills necessary to facilitate conflict resolution at the bedside. In the health care setting, “conflict” can arise when there are miscommunications over a patient’s medication regimen, differing opinions regarding a course of treatment, cultural differences, etc. The courses offered through the Center for Clinical Ethics Mediation take faculty and staff out of the exam room and into the classroom where, through a series of role-playing exercises, they are able to experience firsthand what it’s like walking in their patients’ shoes.


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Courses place faculty and staff from all UPenn entities in role-playing exercises designed to bolster mediation skills

Traditional mediation techniques involve an outside third member bringing together the conflicting parties to reach a resolution. As an alternative to these strategies which can sometimes leave people feeling as though a pre-packaged solution has been imposed upon them, the Center for Clinical Ethics Mediation uses role-playing exercises to place clinicians in real-life scenarios where a health care provider and his or her patient (or the patient’s family, as the case may be), may not see eye-to-eye. The exercises, which can be quite emotional, are designed to help providers to better understand a patient’s perspective and facilitate a conversation and resolution.  

“The biggest lesson was to notice the other person’s position and to force myself to see the other side,” said Victoria Mulhern, executive director of Faculty Affairs & Professional Development, who has attended several multi-day workshops on mediation techniques. “Under certain circumstances, doctors and nurses can impose care, but the discussion process that leads to a resolution everyone is comfortable with provides support and makes bad situations less hurtful. We want our patients to know that we’re on their side, and the only way to do that is to make sure they are an equal part of the conversation.”

In one exercise, physicians are asked to take on the role of an elderly patient whose growing compendium of ailments is making everyday tasks almost impossible. While a physician may immediately see that the best option would be for the patient to enter an assisted living facility, a patient who has always lived a very independent life may not agree. The goal of the exercise is not to make the patient understand “doctor’s orders,” but rather to understand the patient’s perspective and find a resolution that is satisfying for both parties. Other role-playing scenarios, such as when a patient’s family is divided over a course of treatment or when end-of-life decisions are necessary, can be even more emotionally taxing.

“The only way you learn to resolve conflicts, is by resolving conflicts,” says Autumn Fiester, PhD, director of the Center for Clinical Ethics Mediation. “Health care situations can be very stressful and emotional for patients and their families, and sometimes, communication breakdowns can lead to conflict for even the best health care providers. Our goal with these workshops is to provide a better overall patient experience by helping the clinicians to facilitate resolutions that work for everyone involved.”

Fiester says that faculty and staff who complete programs acquire valuable skills that prepare them to manage conflicts caused by communication breakdowns, cultural differences, and disparate value systems. By encouraging open expression of each individual’s feelings, thoughts, values, and perspectives, mediation works to promote shared resolutions to the full spectrum of conflicts between and among healthcare providers, patients, and family members.

Outside of the exam room, Mulhern hopes the skills acquired in the classes will help physicians become better leaders.

“We want our seasoned veterans to lead by example,” she said. “We have so many talented young people coming to Penn Medicine, and we want our leaders to be mentors to them not just in the operating room, but at the bedside and within their own departments. By providing these skills to faculty at all levels, we hope to create improved satisfaction across the board.”

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