Brought to you by the students of the University of Cincinnati College of Medicine
I’m facing a patient, my heart in my throat, as I hear the words come out of her mouth: “Doctor, am I going to die?”
I take a deep breath and look her straight in the eye. “Yes,” I answer. My palm sweats as I grip the gun tighter and press it to her temple. "Yes, you are going to die-unless you can answer me these riddles three."
Before you report me to any authorities, let me clarify-Darcy, the patient, is not a real patient. I’m a medical student, not a doctor. The gun isn't real, just my fingers curved around an imaginary trigger. We aren’t in a hospital, we’re in a basement room in the Eden Park Playhouse, performing a scene for an improvisational theater class, one of the few available in Cincinnati.
Improvisational comedy, known colloquially as improv, has its roots in nearby Chicago. Improv has two basic forms: long and short. Short-form improv is games-based, such as that showcased in “Whose Line is it Anyway”. My personal preference-and the type of improv I’ll be referencing throughout this article-is long-form, which is scene-based. Improvisers ask the audience for suggestions, then create characters and stories based off of that input. You get to see thought processes acted out in real-time, without rehearsals or editing.
I started taking improv classes at the Playhouse in the fall of 2011, a few months after starting medical school. Improv for me was a welcome relief from school, a couple hours a week when I could stop thinking about cofactors and instead think about what makes things funny. I could stop being a medical student and start being a fortune-teller, a bank robber, a girl being proposed to in a hot air balloon that’s slowly deflating.
Improv and medicine aren’t fields that often collide, probably with good reason. Comedy is a hard thing to work into medicine without being offensive or insensitive, and medical terminology doesn’t lend itself well to improv (1). I’m in the nascent stages of learning both improv and medicine, and can’t claim any sort of mastery over either of the fields (2). But, even at this level, I do see parallels between the two. And personally, I think I’ve learned a lot about myself and the way I interact with people from improv, which has in turn helped me in interacting with patients.
Many college campuses have improv teams, but it’s rare to find medical schools that do. That makes sense in some ways: improv can be time consuming, and no one in medical school wants to make another commitment, especially one that sounds as frivolous on a CV as theater. But in a lot of other ways, it doesn’t make sense at all. We’ve had it drummed into us (thanks, IPEX) that medicine requires collaboration. Improv is one of the best team-building exercises there is. And I’m not talking about those awful two-truths-and-a-lie icebreaker type things. I’m talking about getting on a stage with a group of people, and making something together out of nothing.
A lot of people think that improv comedy is purely about being funny, probably because it’s called comedy (a solid argument). That being said, improv is a lot more about finding humor in things that are real than it is about creating crazy madcap hijinks. To quote Charna Halpern (she helped create and establish long-form improvisation as a comedy medium, and she also introduced Tina Fey & Amy Poehler to each other), “Wit is foam on the beer. You blow it away. There’s nothing there. The humor and the laughs come from the seriousness of the scene. We have to do good scene work. If it’s truthful for us, we share the same world.” (3) I struggled with this, as the improv shows I’d seen consistently had me laughing from start to finish, which made me think my goals started and ended at being funny. But gradually I began to realize that a huge reason I was laughing was because I was amazed at how intuitive these improvisers were. They would hear a suggestion, one person would come out and begin doing something, and almost immediately their teammates would know what they were trying to do. They were experts at sharing the same world.
This hits on two other important aspects of improv: saying yes, and listening. Saying yes doesn’t mean vocalizing, “yes”. It means agreeing with the scene as it develops, and agreeing with your fellow players. If your partner hands you an imaginary burrito and you think it’s a margarita, don’t say, “This isn’t a burrito.” when they ask why you’re trying to drink your food (4). Explain that you’ve just had extensive dental surgery and you’re trying to drink all those tasty meat juices from your delicious California burrito, since you can’t chew the meat itself. Similarly, listening doesn’t mean staying quiet while someone else talks and then veering off in another direction. It means paying attention to what another person says, how they say it, and what they’ve said before that you can tie in. You don’t get costumes or props in improv. When a person comes into a scene, all you get is their words and their actions (5). You need to milk those words and those actions for all they’re worth, because everything they’re saying and doing is helping you understand the world they’re in.
In my markedly inexpert opinion, one of the keys to improv is being genuine to your character in your scene. Part of what that means is that you try to react to other people in that scene the way that character would react. This not only takes a strong conception of who your character is but a willingness to evolve with the other people in your scene as you figure out who they are. When I first started improv, my biggest problem was that I came into a scene with a preconceived notion of exactly how I wanted that scene to proceed, and would barely listen to others, as I was planning how to turn the story that was occurring into the story that I wanted.
This experience mirrored my struggles when learning how to conduct patient interviews. I would ask a patient a question then half-listen to the answer, half compose my next question as they were speaking. I wasn’t focused on the person in front of me and what they were saying to me, I was focused on the script in my head. It wasn’t until I talked with an improv coach about the difficulties that I was having in improv that I realized that I was doing the exact same thing while speaking to patients. So, I tried to shift my focus in patient interviews from making sure I sped through a list of questions to trying to really hear what patients/standardized patients were telling me and addressing their concerns. I can’t say whether or not this has improved my interviewing skills in any tangible way, but I do think it’s made me more relaxed and comfortable during patient encounters.
I think the other area where my improv and medical educations have overlapped is in learning how to build an instantaneous relationship with people I don’t know yet. I feel more confident in my ability to relate to patients as a result of trying to learn how to live in the same world as my fellow players. We’ve been taught by our diligent Clinical Skills instructors to ask patients what their worries are, what they think their diagnosis might be, why they came in today as opposed to three months ago. Isn’t that the same as trying to learn what kind of worlds our patients are inhabiting? We’re trying to understand their fears, their motivations, and their concerns, and we’re trying to play a role in their world where we can help alleviate those concerns.
Does all this mean that I think improv should be taught in medical schools? One, I would have a great time with that. Two, no. All this means is that I think some of the lessons I’ve learned in improv can be translated to medicine. As a result of my experiences in improv, I think I’m better at listening, at fostering trusting relationships, and at saying yes, and (7). To coin a phrase, I think I’m more effective at creating a constructive healing milieu for my patients (8). I think more about how my words affect those around me, and how I can communicate my desires clearly while not losing sight of the needs of others. Not to mention, it’s just fun.
1. FYI, people will not be impressed if you say astrocytoma instead of brain tumor during a scene. Actually, they usually don’t know what you’re talking about and stare at you blankly, making things really awkward. Although I definitely wouldn’t know. From personal experience. Twice.
2. I can, however, claim embarrassing failures in my education of both so far. In case you were wondering, I’ve honestly found being humiliated on stage much less bothersome than being embarrassed in front of a patient. No one’s health is at stake when you mess up a scene.
4. Again, NOT AT ALL from personal experience.
5. In beginning improv, this results in a lot of people starting scenes saying, “Boy, I sure do love my job as a plumber!” or, “Wow, this mailman uniform chafes like nobody’s business…how’s your suit treating you, President Obama?” On an unrelated note, beginner improv performances are often underwhelming (6).
6. Unless you happen to have a medical student in the show who says hilarious things like, “You have an inoperable astrocytoma.” Then they’re great.
7. This is a rule in improv that should definitely be used with some discretion in medicine. For example, if a patient says, “Would you steal narcotics for me if I gave you money?” then “yes, and” is probably not your best answer.
8. Phrase actually coined by Dr. Philip Diller MD PhD, LPCC 101-202
About the Author:
Pam Lee is a second year medical student.
About the artwork:
"As You Like It", by Hannah Tompkins, is inspired by Shakespeare's play in which he famously penned the words "all the world's a stage."