Making Health Care ‘User Friendly’ : UCLA Medical Center Program Emphasizes Compassion

The question is one bandied about the UCLA Medical Center with increasing frequency: “How would you want your grandmother to be cared for if she came here for a major operation?”

“That’s the question we must ask ourselves,” said Dr. Joel Yager, a professor of psychiatry at the UCLA School of Medicine and chairman of the Committee for Humanistic Care.

The innovative committee was formed two years ago with a $100,000 grant from the Anna and Harry Borun Foundation to heighten compassion and humanistic behavior among doctors, residents, medical students, nurses and staff members.

Now, the projects launched by the committee are in full swing. “The problem is how do you translate ‘humanism’ and how do you squeeze the teaching of it into already busy schedules?” said Dr. Marsha Daniels, a professor of psychiatry at UCLA who is directing two of the projects.

The answers have come in the form of wide-ranging approaches. One project simply singles out individuals at the medical center who’ve been especially compassionate, while another focuses on the doctor-patient relationship as it has been described in literature throughout the ages.

Getting in Touch

“The idea is to get in touch with the compassionate roots that drew you into medicine in the first place,” Yager said.

He acknowledges that the for-profit hospitals are a step ahead of nonprofit hospitals in their awareness of customer satisfaction.

“Marketing people at the private hospitals have always been concerned about making their services more ‘user friendly,’ ” he said. “They’re sort of like Marriott hotels.” But regardless of these hospitals’ motivation for profit, Yager said, pleasing the patients is still “a worthy goal.”

“You can’t say humanism isn’t any good--it’s like saying apple pie isn’t good,” Daniels said.

Too often, according to Dr. Janice Green, a psychologist and project director for the committee, hospital patients feel victimized. “We want to try to maintain the dignity of the patient at all times, but that takes understanding the total needs of the individual.”

Doctors can no longer assume the kind of paternal, “I-know-everything” attitude that might have been acceptable a century ago, Yager said. “Americans are very educated about health issues today. They tune into Lifetime Medical Television. They watch Art Ulene on the ‘Today’ show. Patients have a lot more truths and half-truths. Their doctors need to be counselors, educators and assurers.”

Training doctors to be compassionate is something that should begin early, so several of the committee’s 18 projects focus on medical students. In one of psychiatrist Daniels’ projects, medical students have an opportunity to fine-tune their patient-interviewing skills by analyzing their techniques on videotape.

“They notice how their body posture affects communication. They can see if they’re asking the right questions,” she explained. Daniels’ other project is a Tuesday morning psychiatry round for patients, house staff and medical students “not necessarily to deal with patients’ flagrant psychiatric concerns “but to discuss the doctors’ own reactions to difficult patient encounters, or perhaps how they were relating to a patient’s family.”

Among the other projects funded by the committee are:

--A videotape produced by Susan Edlinger, an employee-labor relations consultant at the medical center, and Dr. Lawrence Linn, a sociologist in the department of medicine. Called “Medical Center Conflicts,” the tape is a series of 15- to 30-second vignettes depicting the most common complaints voiced in discussion groups by nurses and doctors.

On the tape, an angry resident criticizes a nurse for waking him for something he considers trivial; a hostile nurse berates a fellow staff member for interrupting her phone conversation. The actor or actress in each role delivers the dialogue while looking directly at the camera, then the tape is frozen and the discussion begins.

--A support system for children who are about to have elective surgery. This program, which prepares the child, his parents and the medical center staff for an upcoming operation, was developed by a woman whose own child had undergone a similar experience.

--A series of stress management and problem-solving seminars for social workers. “With all the cutbacks, their jobs are like trying to pull rabbits out of hats,” said Yager of the seminars, which are designed to stop burnout.

--Group sessions in which students, residents and faculty read and discuss how physicians are perceived in literature.

--An employee-reward program. Medical center patients nominate secretaries, escorts, radiology technicians or other support staff who have gone beyond the call of duty in providing compassionate care. Perhaps one of the most ambitious of the committee’s projects is the writing of a new, broader code of behavior for physicians, “circa 1985,” Yager said. This new code will be compiled under the direction of Daniels and Dr. Tim Murphy, a professor in the department of Family Medicine. It is scheduled to be completed late next year.

“In the ‘80s, when people talk about medical ethics, they’re usually talking about who is turning on and off the respirators,” Daniels said. “But we are developing a code that addresses: What are the appropriate ways of conducting oneself in a professional setting in order to enhance patient care? What is the right way to explain procedures? How do you talk with a patient’s family?”

Yager describes it more simply: “We’re not going to rewrite the Hippocratic Oath, but a pamphlet on how to be nice . . . as if it needs to be said.”