Poor bedside manner? Film focuses on future Czech doctors’ communication skills

Film Body–Soul–Patient

The freshly released Czech documentary Body-Soul-Patient maps new teaching methods at the 2nd Faculty of Medicine at Charles University aimed at improving medical students’ communication with patients. But are Czech doctors really lacking when it comes to bedside manner? I discussed this issue, and much more, with the film’s director, Jindrich Andrš.

How did your latest project Body-Soul-Patient come about?

“I wanted to make a film about medical students for a very long time, actually. When I went to study film 10 years ago, I already had it as one of my main topics, because I’m from a family of doctors.

“I was interested in the moment when a medical student is starting to think like a doctor, or starting to feel the weight and the responsibilities it has.

“So I wanted to capture this kind of moment. And when they told me at Charles University that they would like to make a film, I was very happy that I could start working on this topic.”

When you say you come from a medical family, did you ever consider entering medicine yourself?

“Maybe I was considering it, but I was so bad at biology and chemistry and maths in high school [laughs] that I knew very early it was not possible.”

Jindřich Andrš | Photo: Ian Willoughby,  Radio Prague International

A lot of the focus in the film is on how these medical students learn to interact with real people, with patients. If I understand it correctly, it’s a kind of new approach that we see in the film. What exactly it the new thing that they are learning?

“I think it’s a very new approach, because it’s really more about experiencing the emotions in the situations that just handling the skills behind, let’s say, being a doctor.

“You can see that there’s a kind of set-up where they’re in very stressful situations, very difficult, heavy situations, and they have to handle them, from both the doctors’ and the human perspective.”

And this is through role playing? They’re playing out scenarios?

“Yes, that’s true. And it’s actually really new. If you see how doctors are being taught these days, they are sitting and learning theory. And in the Czech Republic this [new approach] is something which is just being developed.”

I have a friend from the UK who had a serious illness and he preferred to travel to England, flying when he was quite unwell, to going to a Czech hospital. He said that in the UK he felt he would meet doctors with a better bedside manner, a better ability to communicate with patients. Do you feel that doctors in this country are lacking some skills when it comes to communication?

Our healthcare system is still going through some revolution from the communist times.

“Our healthcare system is still going through some revolution from the communist times, let’s say, and this is part of that.

“The truth is that doctors here were not previously taught at school how to talk with patients – for example how to tell them serious news about their medical conditions.

“For example, when you see in the film when they do this kind of role play, telling a woman she probably has cancer, this is really a very new thing.

“When I made the film I was in contact with doctors later and I found out that they really don’t use these basics of communication.”

One thing that struck me was how difficult it must be for a fresh medical graduate – I don’t know old that would be, say 28 – telling somebody, You have cancer, or, You have some serious disease. It must be so difficult to learn to do that well.

“They are, like, 23. And I was curious if that was something that you can actually learn. Because if you just talk about it, or read about it, I’m not really sure.

When the students do this kind of role play, telling a woman she probably has cancer, this is really a very new thing.

“That’s also why I’m so interested in the topic of doctors: The profession is very interesting in that you need to have a lot of kind of scientific skills – like how to make a good diagnosis, how to give the right treatment – but for me at the same time it is just as important how you, as a person, are presenting yourself to the patient.

“This is something that wasn’t very well developed in future doctors’ education. And now I think this is a very interesting way how they can learn that – to live it.”

Are Czech doctors seen as kind of gods? Do people bow down to doctors a little bit in this country?

You actually see doctors failing, which I have never seen in a documentary.

“Yes, I think so. And if you think about what is presented in the media, how news stories about doctors are made, it’s mainly on the topic of ‘doctors doing miracles’, in a way.

“I think it’s important also to see them as humans, not as gods. And I think this film is also depicting this topic, because you actually see doctors failing, which I have never seen in a documentary film.

“Of course you are seeing them failing in a kind of experimental environment, not in real hospital situations. But I think we can maybe understand them more, and from the patient’s perspective. And it can be important if we see the background of what they are experiencing.”

We see the students acting out different situations, and even though they’re only acting it’s still really dramatic. And of course there are many fiction TV series and films set in the world of hospitals. Is that environment just inherently dramatic?

“I think the dramatic thing is that in this profession you have much bigger power to influence people’s lives than in most other professions.

“My film is also about that: If a person is experiencing this power for the first time, it can be really difficult.

“When I, for example, first heard about this role-play education I was a bit sceptical, to be honest, about filming it. I thought it would be very fake, that it would be funny.

“And then I was really surprised by the fact they are not really acting, they are kind of more experiencing it. Actually it’s so real. So then I was happy to base my film on these scenes.”

I saw one photograph from the shoot for the film where we see doctors and nurses in masks and scrubs, and then around them your crew, also in masks and scrubs. How difficult was it filming in that environment?

It’s ethically difficult to film patients who are going through surgery.

“It was quite difficult. Because it’s ethically difficult to film patients who are going through surgery. They may not be very aware of what is happening around them, and they could also kind of feel forced, by the situation, to agree to the filming, for example.

“Because we had a very short time. Actually the film was made in only four days, because the budget was really tight – there was not a lot of space for mistakes.

“For example, we were lucky with the one patient lady who we see in the film going through narcosis. We visited her the day before and she agreed, but if she hadn’t agreed we couldn’t have filmed anybody else [laughs].

“So that was a bit stressful. But you know, the miracle is the basic ingredient for a documentary filmmaker, so we experienced it again [laughs].”

Why do you say the miracle is the basic ingredient? Something magical has to happen?

“Yes, and it’s always happening. You are always afraid: Will something happen if I turn the camera on? And actually something happens every time – and very often it’s very amazing.”

The film is on YouTube and is co-produced by the 2nd Faculty of Medicine at Charles University. Why did the faculty want to be involved? What are they hoping to get out of supporting this film?

“We just had the premiere and I met the previous dean of the faculty, and I somehow think that doctors experience such strong stories every day that they somehow feel connected – they know they experience very strong stories and it would be nice if somebody would like to tell these stories.

“They wanted to make a short film as a kind of celebration of the faculty, because they have an anniversary, so they just asked me if I would be interested. But they also gave me complete freedom on what the film could be about.”

I know you’re also working on another, feature-length documentary also set in the medical field. What is that exactly?

“That should be a portrait of the biggest European hospital, Motol hospital, in Prague, which is kind of a city in a few buildings, which I think is really amazing, and through the eyes of medical students.

“At the medical faculty they have a subject where, for the very first time, students can choose a clinic and then work there for just two weeks, experiencing the hospital environment for the very first time.

“So I would like to follow three students at different departments for several weeks.”

I think every hospital is like a kind of village, or community. For example, I have a friend who works at the General University Hospital on Karlovo náměstí and he said they have 5,000 staff.

“Yes, in Motol it’s even 12,000 staff.”

One thing I noticed is that Body-Soul-Patient is about a work environment and your previous film, which you had great success with, A New Shift, was also about work – it’s about a guy who was a miner retraining in IT. Is work something that is particularly of interest to you?

“Maybe I’m interested in some type of drama which is happening when our personal identity is being confronted with some work environment.

“This is something I’m interested in with this [planned] bigger film, because you know that our doctors are working maybe much more than they would be happy working…”

It’s a big issue now with overtime.

“Yes. And then you have these hospitals. For example, you have so many social layers in a hospital and everybody needs to deal with everybody else, somehow, to make it all work.

“For me it’s a very interesting topic: how an individual in this kind of machine can survive, and under which conditions.”

The film Body-Soul-Patient can be watched in its entirety, with English subtitles, here.