PRACTICE PARTNER
if he could meet with the patient privately.
This student had practised mirroring through
the Alda Center. He didn’t use the words
metastatic or malignant. He just talked to the
patient slowly and simply, holding her hand
as she started to cry and ask questions.
“It was the perfect mirror exercise,” the
medical student recounted. “I had been lead-
ing, then she took over and I followed. Ulti-
mately, what emerged was that I helped her
understand death, and she helped me under-
stand how to be a better doctor. It was exactly
what the mirror exercise is about – that level
of connection.”
3
Start at the end
Alda has talked about the work of
Dr. Evonne Kaplan-Liss, a former
actress who worked as a journalist,
then studied medicine and became a pediatri-
cian. She now trains doctors. One anesthesi-
ologist wrote to her and said she had changed
her practice because of one piece of advice
from Dr. Kaplan-Liss. Don’t start with the
details; just get to the bottom line.
The anesthesiologist used to give patients a
lengthy description of what they could expect,
and felt good about her thoroughness. Now,
she begins by saying something like this:
“You’re going to be fine. I’m here to keep you
safe and comfortable. You’re not going to be
in any pain.” Patients visibly relax. Only then
does this anesthesiologist get into the specifics.
Think of what patients want and need to
know most, and give it to them first. The rest is
background.
4
Create a narrative
On Clear + Vivid Alda inter-
viewed Dr. Karl VanDevender,
who described his approach to first
visits. He has a blackboard in his office, and
has patients go through a timeline of their life.
Just the act of writing things on the board in
their presence shows that you’re listening. Then
Dr. VanDevender puts what he’s learned into
narrative form. The patient can add to it or
change it.
Patients aren’t a series of checklists to
mark off, a catalogue of complaints or a set
of symptoms. They’re walking narratives.
“Everybody has a story. Everybody has a life
experience that has texture and meaning to
them,” says Alda.
MD
ISSUE 2, 2019 DIALOGUE
37