A hospital drama that gives doctors a tonic
A theatre group is trying to cut medics’ stress and improve their bedside manner.
‘Learning to touch people in a way that makes them feel safe is good’ ‘The stakes are much higher when doctors get tired’
It’s a Thursday evening in an east London studio, and 20 junior doctors, medical students and healthcare professionals are lunging around the room as though their drinks have been spiked, or their spines swapped for jelly.
Suzy Wilson, artistic director of Clod Ensemble, the theatrical group choreographing the gathering, is shouting over the kerfuffle: “Hopefully this is not a state that you will ever be in, but your patients might be.” Knowing grimaces are exchanged.
According to Wilson, this is the first state of tension; ie, none. Limbs are loose. Brains are disengaged and there are bodies all over the place. A few minutes later, the class is crashing about at speed, banging into each other and ricocheting off the walls. This is state seven – the highest. What part of your job does this remind you of, asks Wilson. “A&E!” everyone shouts back.
So begins a Performing Medicine class; part of a programme created by Wilson and her company to inject fresh energy, compassion and selfawareness into flagging NHS staff.
Throughout the year, in studios and hospitals around the country, her troupe put on classes and workshops imparting traditional arts training to careworn doctors, nurses, consultants and medical students.
Her thesis is that doctors are so busy being doctors that stress gets the better of them, they forget their people skills and their bedside manner takes a hit – if it was ever mastered in the first place.
“We think of those in the medical profession as people with a lot of power, but actually there are many who feel they could do with some support,” says Wilson.
Classes centre on vocal clarity, spatial awareness, resilience, non-verbal communication and teamwork. They encompass how to sit comfortably in silence when delivering bad news, how to decompress physically after a long day, and the warning signs you are running on empty. There’s advice on how to react to crash calls, speak in a tone that inspires confidence and deal with vulnerable patients (the latter involving an exercise where pairs lead one another around a room, taking it in turns to have their eyes closed) – all of which can easily be overlooked in the regimented world of medicine.
“In healthcare, certainly, some of the skills that we focus on here are not mentioned. The use of breath to communicate clearly in any drama school is completely fundamental. I work with nurses or medical students in their fifth year and no one has ever talked to them in a training environment about that before.”
Arguably, these classes have never been needed more. As the junior doctors’ dispute rumbles on and NHS workers, at all levels, report increasingly unmanageable workloads, bedside manner is often the first thing to go – with obvious repercussions for patients. One study found that depressed patients given placebo pills by an empathetic doctor ended up with better results than those taking an active drug from a psychiatrist who seemed less concerned about their welfare.
And though compassion has been a key NHS buzzword since the fallout from the Mid Staffordshire hospital scandal, data released by the Care Quality Commission last week suggests it is still in dangerously short supply in some areas, with more than 40 per cent of hospitals offering “indifferent or poor care” of the dying.
Of course, compassion cuts both ways. A British Medical Survey of more than 2,800 GPs, also out last week, found that more than 20 per cent said the stress of their work had made them ill in the past year.
“The stakes are much higher within healthcare when people get tired or feel oppressed,” says Wilson.
She was inspired to try to revive the art of medicine when she saw the positive impact of compassionate care on a friend’s stay in hospital. Since its creation in 2001, Performing Medicine has seen 12,000 people pass through its programmes, and the group has established links with Barts and the London School of Medicine and Dentistry, King’s and Imperial Colleges, as well as hospitals in Bath and Essex via Health Education England.
They began working with medical students in 2006 – attendance is compulsory in some medical schools – and their numbers have steadily increased since. Funding comes from Guy’s and St Thomas’ Charity, Arts Council England and Wellcome Trust, and classes are mostly free, if you are a practising healthcare professional.
“Of course, it is not everyone’s cup of tea and there can be resistance,” says Wilson. “But, honestly, very little.”
Junior doctor Clara Belessiotis, 28, who works in A&E at North Middlesex Hospital, agrees there will “always be a degree of scepticism”, given that theatre and science are seen as polar opposites. “It is intimidating – it is performance, theatre and voice work.” She first came across Performing Medicine four years ago, and believes the workshops have had a measurable effect on her communication skills.
“Obviously medicine is interacting with people in vulnerable positions, but there is also a lot of negotiation with your seniors and other healthcare professionals, and with people who are often angry or aggressive. This teaches you to think creatively.”
She references a recent scenario in which she intervened in A&E, where a colleague was coming under fire from a family who didn’t speak English and were audibly angry with his diagnosis. His approach, to ignore them, only inflamed tensions further, until she approached, confident she knew how to pitch her tone and body language in a way to diffuse the situation. It worked.
“It sounds corny, but Performing Medicine covers the power of touch. We spend a lot of our time touching people, so learning to be able to do that in a way that makes them feel safe and not threatened is good.”
A 38-year-old sonographer from south-east London, who didn’t wish to be named, says elements of classes have even helped her navigate a promotion: “Sometimes managers can be difficult, so I try to do things like matching their body language to see if that will help. Also, looking up. I learnt that I look down a lot, which is not aspirational.”
She also uses a tactic of punching the air “like American football teams do before they start playing” to make her feel “confident and positive” before a big meeting or appointment.
“I do it in a closed room,” she is at pains to point out. “If people saw me, they would think I was weird, but it does work. I told a colleague about it and she now secretly does it too.”