On the other side: listening to patients

Alita Anderson, M.D. ’01, scrunched her face, squinted her eyes, and yelled, “JESUS! Jesus!” In a voice that was sometimes honeyed, other times squawky, she was portraying for an audience of first-year medical students a frightened woman named Ruby.

Then she took on the persona of a 34-year-old Vietnam vet who struggled with drug abuse and alcoholism.

The Atlanta native, who founded and leads her Georgia-based consulting firm, Eubio Medical Communications, knows the stories shared by this man and woman well. She’s been performing this cultural awareness exercise in various iterations at Yale for nearly 15 years. Her goal is to convey to new medical students how cultural differences between patients and doctors can easily go unrecognized, to the detriment of the doctor-patient encounter. As a medical student, Anderson collected, wrote, and published oral histories in a book based on her research for her thesis. And she first performed the stories for her classmates and faculty at a student talent show.

“When I saw her perform I was blown away. I’ve never been moved like that,” said Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, associate dean for student affairs. She recruited Anderson to reenact the histories for first-years.

For her performance in The Anlyan Center auditorium in August, Anderson continued with the format suggested by Angoff over 15 years ago. She acted out stories from her book, On the Other Side: African Americans Tell of Healing, and projected on a large screen were clinical patient histories based on those stories. Sitting on a chair beneath the screen, Anderson gave Ruby’s account of her life with details that did not appear in the medical record. Ruby’s story began with an event from five decades earlier—when she met Isaiah, the love of her life—and described their courtship and marriage up to the incident that brought them to the hospital.

Her chart read: “77-year-old African-American female presents to emergency department after she and husband held up at gunpoint. Patient is a poor historian.” The reason for her visit according to her chart? “My nerves are bad.” When Ruby approached the crucial moment, just after a young man bent on robbery entered her home with a gun, she repeated the name that comforted her, “Jesus,” until her speech became strangled with fear. The medical record was curt: “Per police, husband scared off intruder by shooting at him. Patient denies chest or shoulder pain, shortness of breath, or diaphoresis.” Through her story, Ruby conveyed the stress and pain-in-the-heart trauma of the experience. But based on her medical chart, a clinician might think Ruby had a vague, undefinable discomfort.

In her second narration, Anderson portrayed a young man who earned $50,000 a year at his railroad job in Indianapolis before getting shipped off to Vietnam. When he came back from the war, the religious young man got mixed up in all the things that he’d learned as a child were forbidden: smoking, drinking, gambling. Later, in the emergency department, his medical record mentions his drug abuse, but not his military service. The doctor writes: “34-year-old African-American male brought in by police—drug overdose? Social history: cocaine abuse, 100 pack-years of tobacco, chronic alcoholism, previously known to be homeless.”

After Anderson’s performance, Angoff asked the students to discuss the differences between the stories and the medical histories. “The medical history has to convey a very limited amount of relevant information quickly so health care staff know what is going on,” one student said. Audience members nodded in agreement. “I think the physician was condescending when he or she wrote Ruby’s current condition as a quote that says, ‘My nerves are bad,’” said another student. Another student observed that the young man’s medical record came across as overly negative, even though the man described in his story how he tried to deal with mental illness.

At the conclusion, Angoff encouraged students to continue to search for and recognize cultural differences and their own implicit biases during their interactions with patients. “What I hope students get out of this is that patients have stories upon stories upon stories,” Anderson said after her performance. “And as physicians, they will hear only one—very short—story.”