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Class trains doctors for the toughest conversation

Story Highlights

• Emory doctors-in-training must take class on delivering end-of-life news
• In classes, doctors interact with actors portraying grieving family members
• Doctors graded on eye contact, body language and use of medical jargon
By Judy Fortin
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ATLANTA, Georgia (CNN) -- It's been more than a decade since her 13-year-old daughter, Maria-Victoria, died in a car accident, but Lynda Boucugnani will never forget the doctor who delivered the news. "I remember he sat down, but his first words were, 'Your daughter is deceased.' That just struck me as so cold, so cold," says Boucugnani. The experience was horrendous, she says. "I expected a little bit more compassion ... there was no, 'I'm sorry,' no touching my hand. These things would have meant the whole world to me."

Boucugnani, a psychologist in Atlanta, Georgia, understands that doctors are busy and can't take the time to get involved in every case, but to this day she remains angry. "What I have is this memory of this cold, detached person telling me that my daughter, who was my life, is gone, and in a very clinical way," she said.

Dr. Tammi Quest thinks she's found a way to make sure no loved one at her hospital ever has to go through what Boucugnani experienced. Quest has developed a specialized curriculum at the Emory University School of Medicine in Atlanta that teaches the art of compassionate communication. She's hoping classroom work and simulation exercises will change the way future doctors conduct end-of-life conversations. (Watch how doctors learn to deliver bad news more compassionately. Video )

"I think that all of us struggle with interpersonal communications," said Quest, who specializes in emergency medicine. "This is absolutely no different."

The course is mandatory for Emory medical residents -- new doctors in post-graduate training. In addition to lectures, they work with actors hired to portray grieving family members.

Leigh Miles is one of a dozen young doctors taking part in a scenario in a mock exam room. She's training to be an emergency room physician.

Miles is hoping the practice sessions will prepare her for a real-life conversation. "It's never going to be pleasant, but I would like to go into it with tools or some kind of knowledge of how I could make such a bad thing slightly more comfortable."

Participants such as Miles are graded on eye contact, body language and whether they used medical jargon to convey the news.

Quest relays her own experiences with patients' families to the doctors while standing at the front of the classroom. "They might not remember your name, but they will remember exactly the phrasing you used, how you said it, if they were confused," she tells the doctors. "People can recall that event very, very vividly. People can relive that and replay that." To avoid any confusion or misunderstanding, she advises the doctors to choose their words carefully. Instead of saying "passed on" or "not going to make it," she tells them to be straightforward. "I've seen family members be confused when someone goes in to talk about the news of death and (the doctors) can't actually say the person has died."

Quest doesn't think doctors mean to be callous, but may fear being drawn into a family tragedy. "I think that what this workshop does is that it allows people to know that they're going to go in and get absorbed, but to not have fear that it's going to be this bottomless pit and that they're never going to come out."

Miles worries about that, too. "The challenge for me is to not take that home and be so upset about that for days, weeks and months on end, because the next day, I've got to get up and do the very same thing."

When the role-playing is over, the actors critique the doctors. Often, the doctors are asked to evaluate themselves. When asked what he learned, another new doctor, Colin Dircks, says, "I think to make the most of the short time that I am able to spend with the family."

Families like Boucugnani's will remember that kind of thoughtfulness for years to come. "It's just part of being a person in the show compassion for other people, and it's not hard," says Boucugnani. "If doctors are taught to do this and they feel comfortable with it, it will make a big difference."

CNN Medical News producer Leslie Wade contributed to this report.


Emory University doctors-in-training must take a class on end-of-life conversations. In workshops, the medical residents practice with actors.


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