Yes, and…

“Thank you for role-playing with me,” said the standardized patient, a hired actor playing the role of a patient in clinic, as I finished taking his ­history of present illness. When he first said “role-playing,” it seemed a little strange to me. The term conjured images of playing house with my neighbors and always fervently insisting on playing the dog. Thinking about it further, I realized that is exactly what we were doing. Just as the actor was pretending to be my patient, I was pretending to be his doctor. I had, in essence, memorized a script. I learned the main points of the history I needed to elicit and then had to prepare myself to improvise with the information added by the patient. At the end of the “scene,” we both came out of character to talk about what worked and what didn’t. “Keep your strong eye contact” but also “speak slower when asking sensitive questions” were his suggestions on the performance I had given.

A lot of medical school has been about learning how to ad-lib, collect information, analyze tests, and generate a plan, all while interacting with someone else who adds new information. When it comes down to it, a good physician is like a skillful improv comedian. After given information from the patient, the physician must then improvise using a box of tools, knowledge, and resources, to create a story with the patient. Just as an improv comedian must practice in multiple shows before developing the intuition to read a fellow actor, anticipate where a scene is going, and drive the plot of a show forward, so must medical students learn the “art” of interacting with patients.

Thinking forward into my career, I wonder if we ever stop acting and the patient encounter becomes second nature. In clinic, I have observed experienced physicians give the same explanations to different patients with such skill and fluidity that you would not be able to tell it was rehearsed and repeated. In a way, these “monologues” on how the flu shot works, how older patients can improve their balance, or how an antibiotic should be taken have been flawlessly incorporated into their toolbox and are readily accessible if the plot of the encounter renders them appropriate.

For me, even in the first few months, I have felt some of my history taking start to become natural. After introducing myself to a “patient,” I seamlessly follow one question with the next as I elicit the story of what brings the patient in today. Sometimes, I lose the natural progression and must deliberately refer to my mental list of important topics to hit, just like an actor calling for a line. I think with time and practice, I will start to embody my character of physician. At the same time, some separation between that role and my life outside of medicine will be beneficial. Considering the emotionally taxing nature of medicine, being able to switch between roles may promote my well-being and leave me better equipped to face the emotional challenges that come with the territory.

While my knowledge of improvisational theater is limited, I do know that a key concept is to always say “Yes, and…” This means always accepting what another actor says and expanding on that line of thinking. To me, this has immense value in the “scene” of the clinician-patient encounter. “Yes, and…” means I acknowledge what you are saying to be valid and want to know more about why you are saying it. It means, I am listening and I care to dig deeper. It shows that the doctor is willing to cooperate and build upon what the patient is saying. In this way, we create narratives with our patients. Each encounter adds to a rich history that can help us best treat our patients and determine where the plot is going next.