GPs: acting the part

Dr Ed Warren is an obviously learned and wise middle-aged general practitioner who practises in Sheffield, in the United Kingdom. His thesis is that doctors have much to learn from actors, whose skill is to understand human motivation and communicate to their audience how it influences behaviour. So he has come up with the “BARD” approach to improve performance in a consultation.

B is for behaviour, with an emphasis on the non-verbal kind through which over 50 per cent of interpersonal communication occurs.

A is for aims — the broad direction in which a GP wishes to progress the patient and other stakeholders in the achievement of said aims. Here Warren introduces the concept of “the good enough consultation”. The essential components are securing the patient’s safety and ensuring that both patient and doctor are proceeding in the direction of their aims. The doctor/actor doesn’t have to compress the whole play into one 12-minute scene. There will be more scenes and acts to follow.

R is for room and is equivalent to the theatre in which the action takes place. This includes the approaches to the building, the interior layout and the costume of reception, nursing and medical staff.

D is for dialogue — the process by which doctor and patient try to adjust their transmitters and receivers to the same frequency. A novel suggestion is the use of voice lessons.

The last two chapters in this book are on training for, and the ethics of, becoming a BARD GP. But this is not a syrupy “How to win friends and influence people” book. At no stage does the author suggest readers adopt behaviour incongruent with their beliefs and personality. Rather, the author wishes to transpose elements of Stanislavski’s “be yourself” method acting to the medical consultation.

This book is an innovative addition to the literature on improving one’s consultation skills. Actors and sportspeople train to optimise their performances, as do spokespeople for the Australian Medical Association. So why not GPs? Reading this book is guaranteed to improve the consultation skills of even the most accomplished GPs. It has particular relevance for registrars and their mentors.

Max KamienEmeritus Professor of General Practice, University of Western Australia, Perth, WA