Teaching Doctors to Think Like Patients

Dermatologist Michael Marchetti speaks with a patient about treatment options for melanoma.

Dermatologist Michael Marchetti speaks with a patient about treatment options for melanoma.

The doctor-patient relationship can be fraught with sensitive issues. For doctors, delivering bad news (or even good news) delicately, discussing treatment options, even handling anger or sadness can define whether communication is successful, and whether the dynamic is a positive one.

A recent segment on the Brian Lehrer Show that dealt with this topic featured Philip Bialer, Interim Director of Memorial Sloan Kettering’s Communication Skills Research and Training program, or Comskil, an innovative program that’s been teaching doctors how to improve communication with their patients since 2005.

About 100 fellows and residents at MSK are required to participate in a Comskil course every year as part of their oncology training. Subjects covered include how to break bad news; discuss prognoses and treatment options; respond to patients’ anger; help the transition to palliative care; and handle end-of-life care, death, and dying.

Everyone Is Different

“A lot of the focus is on making things patient centered and trying to encourage our physicians to check in with our patients,” says Dr. Bialer. “We devised this course to make us more empathetic and to better understand our patients’ needs.”

 “For instance, when talking about prognosis, sometimes patients don’t want a lot of specific information,” he says. “They might want more general information. It depends on the patients. Our focus is on emphasizing that not all patients are the same.”

We devised this course to make us … better understand our patients' needs.
Psychiatrist Philip Bialer

Empathy and sensitivity may be tough skills to teach, but Dr. Bialer says there’s evidence that the course is helping physicians — and that most doctors have an innate sense of kindness. “There are certainly improvements with some of the fellows, but many are already starting from a very high place. I think that says something about the kind of person who chooses to go into this field. They already come with a high level of compassion.”

Modeling Good Behavior

To evaluate its effectiveness when the program first began, Comskil staff would record an in-person meeting between physician-trainees and first-time patients who agreed in advance to participate. Today, doctors interact with actors playing patients, so they can by evaluated on the complete spectrum of skills. Before each scenario, facilitators give the actors instructions — for example, asking them to weep or to react with anger, or to show any of the range of emotions a patient might experience.

At the conclusion of a scenario, doctors are able to view a video to see exactly what they were doing and learn where they can make improvements. Doctors also receive feedback from the facilitators, and even from the actors, who often remain in character to deliver their assessments.

One of the first physicians to take the course was medical oncologist Maura Dickler, a breast cancer specialist.

I'm always checking in with [patients], taking stock of what they heard.
Breast cancer specialist Maura Dickler

 “You’re always finessing your communication,” Dr. Dickler says. “When I tell women about early-stage breast cancer, for example, and I tell them their diagnosis and options for treatments, I’m always checking in with them, taking stock of what they heard and having them repeat it back to me. I give them time to answer.”

She is among a number of physicians who went from being a student of the program to then becoming a facilitator. She says she continues to use skills she learned in Comskil day after day. “To be honest, many of those skills are very useful in my own life. Communicating with our children and spouses, we sometimes forget that these are life skills.”


There is good and bad in every business, however you do not expect the professional staff, for the most part, to make discriminatory comments. A highly sought after surgeon demonstrated poor "bedside" manners in a very shocking way by mocking Hispanic culture and language. Sorry to see this happen in today's day and age, from a surgeon who himself is Asian. Not going back and I severely recommend not choosing this hospital, the perception here was arrogance in abundance. Sad.

We are very sorry that you or one of your loved ones had this experience. Our Patient Representatives are committed to ensuring that your rights are respected and that your concerns are addressed. We have sent them your concern, and you can contact them directly at 212-639-7202 to discuss this in more detail. Thank you for your comment.

I believe it is equally important to train a doctor's staff and nurses to be sensitive and compassionate with patients who have the most dreaded diagnosis - cancer. Most people at MSKCC are kind and supportive. However, I have had a few experiences with "nasty bullies", not MDs.

Barbara, we are sorry if you had a bad experience with some of our staff. Our Patient Representatives are committed to ensuring that your rights are respected and that your concerns are addressed. We have sent them your concern, and you can contact them directly at 212-639-7202 to discuss this in more detail.

is there a comskil program for nurses ?

I went through the Comskill training as a fellow and it was the best (and most terrifying) experience. It has continued to mold and influence my patient interactions and now many years later I am a facilitator for residents and medical students at my institution. Thank you for this training as it has "paid forward" to thousands of patients. Dr. A

Hi Rebeca, we’re so pleased to hear that you found your Comskil training valuable. Thank you for your comment.

I'm a working actress and a fellow actor told me that your Comskil program employs actors in their training program. .Can you tell me how to apply?
Thanks so much!

Dear Sheri, if you interested in applying to work in the Comskil program, you can contact Comskil Manager Shira Hichenberg at hichenbs@mskcc.org. Please be sure to include your head shot and acting resume. You can contact Shira at 646-888-0212 for more information. Thank you for your interest in MSK.

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