Geropsychologist Lauren N. DeCaporale-Ryan, PhD, works at the University of Rochester Medical Center, but her focus isn't on patients.
Instead, she focuses on the physicians, surgeons and other clinicians who care for them. As an assistant professor embedded in the psychiatry, medicine and surgery departments, her job is to improve care by helping health-care providers communicate more effectively with patients, families and each other.
"My role is different from that of anyone else I know in psychology," says DeCaporale-Ryan, who earned her clinical psychology doctorate from the University of Missouri–St. Louis in 2011.
DeCaporale-Ryan spends her day doing rounds with individual clinicians or teams, observing surgeons, physicians and other clinicians as they interact with patients. With each physician/patient encounter, she tracks a series of behaviors, such as how they greet patients and even whether they smile. She then provides immediate feedback or follows up one on one to tackle problems.
Interactions between surgeons and patients typically last less than three minutes, so DeCaporale-Ryan teaches surgeons how to be warmer so patients don't feel they're just a number to be checked off. With physicians, whose interactions last longer, the goal is to boost efficiency so they don't get burned out by day's end.
"In surgery, I'm encouraging people to slow down," says DeCaporale-Ryan. "In medicine, I'm encouraging them to speed up."
DeCaporale-Ryan suggests, for example, that physicians ask patients about their concerns at the beginning of sessions to avoid the common problem of patients bringing up new topics just as physicians head out the door. With a physician who never smiled, DeCaporale-Ryan suggested that he build on his natural tendency to incorporate touch — shaking hands or patting patients on the shoulder — in every encounter. "He observed for himself that this was quite effective," says DeCaporale-Ryan. "Patients were responding to him more warmly."
She also teaches physicians how to communicate with each other more effectively. With a grant from the Institute on Medicine as a Profession and the Josiah Macy Jr. Foundation, DeCaporale-Ryan, APA President Susan H. McDaniel, PhD, and an educational psychologist are helping surgical faculty give more constructive feedback to residents and to each other.
To go into the operating room and operate on another human being, you have to be able to separate yourself from your feelings, says DeCaporale-Ryan, adding that surgeons' focus has always been on technical expertise rather than interpersonal communication skills. Surgeons must often act quickly in the operating room, limiting the opportunity for constructive communication and occasionally resulting in their shouting directives at residents, she says. Residents sometimes express frustration that surgeons are inconsistent when it comes to following up with them about how they could or should have navigated something differently in the operating room or in patient care delivery. The new faculty development project will teach surgeons how to determine when and how feedback is best delivered to improve the learning environment.
DeCaporale-Ryan is also working to ensure that clinicians communicate with families, who are often ignored. "Ninety-nine percent of the time it's not on purpose," she says. "It's a sense of urgency, feeling rushed."
In another project, DeCaporale-Ryan and colleagues will help clinicians function better on teams. Funded by the university's Institute for Innovative Education, the project will feature a physician, social worker and nurse practitioner training interprofessional teams as they care for actors posing as patients.
Another priority for DeCaporale-Ryan is preventing burnout among residents. "If you have burned-out physicians, they're not effectively caring for patients," she says. She and her surgical colleagues are launching a wellness program that will offer social activities outside the hospital, information on financial planning and healthier snacks in resident lounges.
DeCaporale-Ryan also sees some patients of her own — primarily older adults — in the hospital's family medicine program, where she did a two-year postdoctoral fellowship. She doesn't just get referrals from this primary-care setting. Thanks to her work with the surgery department, many patients are referred to her by surgeons.
"What family medicine has long done quite well and surgery has begun to catch on to is that it's useful to have a team of people working with a patient or family rather than trying to take on all their needs alone," says DeCaporale-Ryan.
At Missouri, she says, older adults preferred to use primary-care clinicians, religious resources or support groups rather than the university's community clinic. DeCaporale-Ryan saw a different model during her internship at the Central Arkansas Veterans Healthcare System, which included a rotation in which an entire team provided home-based primary care.
"I recognized that to provide effective care for geriatric populations, the setting needed to be integrated," says DeCaporale-Ryan. "With integrated environments, there's not so much stigma and they can more easily access care."
