Sometimes, in the doctor鈥檚 office, it鈥檚 what goes unsaid that鈥檚 the real story.
The patient, there to discuss her weight: 鈥淚 wonder if he鈥檒l make me get up on the scale.鈥� 鈥淚 don鈥檛 know what鈥檚 wrong with me.鈥� 鈥淚鈥檓 doing everything I鈥檝e been taught, but it鈥檚 not good enough.鈥�
The doctor: 鈥淢y patients want the quick fix. They want the latest diet.鈥� 鈥淚 don鈥檛 have time to develop a relationship with my patients.鈥� 鈥淗ow can I tell her I have nothing to offer?鈥�
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.
Heartbreaking stories
Every line of the mini-drama, called 鈥淏ehind the Scenes,鈥� is a real statement from a real person. They鈥檙e 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.
鈥淚 cried when I read some of the transcripts that we had; it鈥檚 powerful stuff鈥� says Dr. Kirk, an internationally renowned obesity expert and Canada Research Chair in Health Services Research. 聽
鈥淵ou read these people鈥檚 stories that are absolutely heartbreaking, the way they鈥檝e been treated. This is an issue that, for many people, consumes their lives, and we have to be mindful of that when we鈥檙e working with them [as health-care providers].鈥�
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, 鈥淏ehind the Scenes,鈥� 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 鈥淏ehind the Scenes鈥� 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 鈥� from nursing to nutrition 鈥� their varied perspectives shape the dialogue into new directions.
鈥淲e rewrite it every time we go in front of an audience,鈥� explains Dr. Price, who brings expertise in interpretative/narrative methodologies to the project. 鈥淲hat we鈥檒l end up with is a revised way of approaching that working relationship that鈥檚 been entirely rewritten by health professions students. Some of it鈥檚 representative of what we had at the start, but each stop there鈥檚 something new the students add, something we hadn鈥檛 thought of.鈥�
Solving the stigma
The students quickly pick up on the play鈥檚 many tensions and how, in many ways, the clinician feels as frustrated by the system鈥檚 strains as the patient does.
鈥淲e wanted to get at that relational experience,鈥� says Dr. Price. 鈥淥ur study showed that health-care practitioners often work and think in siloes because we鈥檙e 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.鈥�
鈥淲e see a lot of resilience among people who are living with obesity,鈥� adds Dr. Kirk. 鈥淭hey 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鈥檛 always change. We鈥檝e 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.鈥�
Funded by the Canadian Institutes of Health Research, 鈥淏ehind the Scenes鈥� wraps up later this month with a final workshop at Memorial University. While the researchers hope to publish the results of the project, they鈥檙e even keener to look at ways to broaden the use of this sort interpretative approach, and perhaps take elements of the project nationally. There鈥檚 a palatable enthusiasm when they start to brainstorm possibilities for the future.
鈥淚n all my years of research, this is the coolest project,鈥� says Dr. Kirk.
Dr. Price agrees. 鈥淚t鈥檚 the most proud I鈥檝e been as a researcher.鈥�
"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" 鈥� Kirk SFL, Lyons R, Aston M,聽 Price S, Rehman L, Vallis TM, Curran J. 2009-2012.