Sometimes, in the doctor’s office, it’s what goes unsaid that’s the real story.
The patient, there to discuss her weight: “I wonder if he’ll make me get up on the scale.” “I don’t know what’s wrong with me.” “I’m doing everything I’ve been taught, but it’s not good enough.”
The doctor: “My patients want the quick fix. They want the latest diet.” “I don’t have time to develop a relationship with my patients.” “How can I tell her I have nothing to offer?”
The Dal students gathered in the McInnes Room back in November watched as performers Frank MacLean and Carolyn Thomas acted out the consultation as the clinician and patient, respectively. There was a marked difference between what the characters told each other and what they told the audience in monologue: their secret confessions included their fears, their worries, their sense of being stuck in a system with no solution.
Every line of the mini-drama, called “Behind the Scenes,” is a real statement from a real person. They’re based on dozens of interviews conducted by Dal researchers, led by Drs. Sara Kirk (School of Health and Human Performance) and Sheri Price (School of Nursing), with patients, care providers and government officials. Together, the comments help paint a picture of the way obesity is managed within modern health-care system, and the systemic weight bias, stigma and blame that goes spoken and unspoken.
“I cried when I read some of the transcripts that we had; it’s powerful stuff” says Dr. Kirk, an internationally renowned obesity expert and Canada Research Chair in Health Services Research.
“You read these people’s stories that are absolutely heartbreaking, the way they’ve been treated. This is an issue that, for many people, consumes their lives, and we have to be mindful of that when we’re working with them [as health-care providers].”
The researchers felt these stories deserved a broader audience than simply those who would read about it in an academic journal, and felt particularly compelled to share them with the next generation of health-care providers about to enter a challenged, strained system. Hence, “Behind the Scenes,” which weaves those stories into an interactive play that gives students the opportunity to help rewrite the script.
This fall, Drs. Kirk and Price took “Behind the Scenes” on the road, hosting interactive, interprofessional workshops with students at UNB, UPEI and here at Dalhousie. At each workshop, students watched the performance and then split into groups to talk about how both the health professional and patient could have acted differently. Because the students come from various health-care fields — from nursing to nutrition — their varied perspectives shape the dialogue into new directions.
“We rewrite it every time we go in front of an audience,” explains Dr. Price, who brings expertise in interpretative/narrative methodologies to the project. “What we’ll end up with is a revised way of approaching that working relationship that’s been entirely rewritten by health professions students. Some of it’s representative of what we had at the start, but each stop there’s something new the students add, something we hadn’t thought of.”
Solving the stigma
The students quickly pick up on the play’s many tensions and how, in many ways, the clinician feels as frustrated by the system’s strains as the patient does.
“We wanted to get at that relational experience,” says Dr. Price. “Our study showed that health-care practitioners often work and think in siloes because we’re educated in siloes. So the sooner we give them the opportunity to learn with, from and about one another, then they have a tangible way for them to see how they can work better in the field.”
“We see a lot of resilience among people who are living with obesity,” adds Dr. Kirk. “They are really challenging the system, but the system is structured in such a way that you can challenge it all you want, but it won’t always change. We’ve got to really look at those system-level issues, towards the policy makers and those who decide where and how money is allocated in the system.”
Funded by the Canadian Institutes of Health Research, “Behind the Scenes” wraps up later this month with a final workshop at Memorial University. While the researchers hope to publish the results of the project, they’re even keener to look at ways to broaden the use of this sort interpretative approach, and perhaps take elements of the project nationally. There’s a palatable enthusiasm when they start to brainstorm possibilities for the future.
“In all my years of research, this is the coolest project,” says Dr. Kirk.
Dr. Price agrees. “It’s the most proud I’ve been as a researcher.”
"Behind the Scenes" is based on an original research project funded by the Nova Scotia Health Research Foundation called "Balancing the scales: Promoting healthy weight management without blame or shame" – Kirk SFL, Lyons R, Aston M, Price S, Rehman L, Vallis TM, Curran J. 2009-2012.
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