Making magic in medicine

During last year's annual convention of the International Brotherhood of Magicians, I met Jeff McBride and Eugene Burger, faculty from the McBride School of Magic in Las Vegas. As I watched them teach and perform, I realized that much of what they teach at their magic school could provide valuable skills and insights for practicing physicians.

As a result of many years of practice, both McBride and Burger have developed the interpersonal skills to ensure close cooperation with their audience. When Burger hands a deck of cards to a spectator, he knows exactly what to say and do to ensure that the spectator follows his advice correctly and completely. If we as physicians could be nearly as successful, what a boon to our patients' health that would be!

And there's no reason we shouldn't be successful: There are numerous parallels between the role of the magician and the role of the doctor. Both conjurer and physician need to establish a positive connection with their audience in a short time. Both have to create an impression of skill and capability. Both need to direct attention to that which is important, and away from what isn't. Both need to understand how to recast confrontational or distrustful attitudes into those of cooperation and faith.

Establishing a strong physician-patient relationship has always been the foundation of the therapeutic process, and one of the most important issues in any relationship is keeping the lines of communication open and direct. A magician's skills in voice control, the ability to focus and eliminate distractions, and command of body language can be utilized by physicians to create and maintain the sort of relationship that encourages patient compliance and loyalty. If you make an effort to see yourself from your patient's perspective, you may find that you can increase the impact of your communication and foster better rapport.

Establishing rapport begins the moment you enter an exam room. "Your first impression has to be persuasive and focused on the effect you want to achieve," says McBride. Modern doctors have to keep so many issues balanced in their heads during a patient visit that it is essential to have a clear plan of action and a routine to make sure that all concerns have been addressed. Just as a performer must eliminate all distractions before walking onto a stage, a doctor needs to do the same before entering a room. Take a few moments to compose your thoughts before you open that door. Clear your mind of issues that don't relate to the situation at hand, and try to create intention within yourself to be totally present with the patient. Keep in mind that although this may be a routine episode for you, this may be the most important event in the patient's day. Remember as you breathe that to inspire can also be seen as a way to communicate.

Once you enter the room, immediately establish eye contact and closely observe the patient before you engage her in dialogue. This way you will pick up subtle cues from the patient's posture and facial expression that would be lost if you hurriedly launch into your questions and exam.

Our voices are powerful tools when used skillfully. But how many of us have explained a procedure or regimen to a patient, only to later discover that they retained nothing of what we said? Many doctors speak too rapidly, and the patient is overwhelmed with information. Part of the problem may be that you use medical jargon when simpler words would work. Perhaps you're too soft-spoken or tend to mumble. Patients may be too intimidated to ask you to speak up!

Practice speaking in front of a video or tape recorder placed a few feet away, at about the height of a patient's head. Talk as you normally would. Then play back the tape while you stay the same distance from the recorder. See if you can make out each word clearly and if you use simple language and speak slowly. Pausing between sentences will allow you to note if the patient is following you or needs more clarification.