How improv helps physician leaders [PODCAST]

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“Signing up for an improv class was unchartered territory. It was far beyond my comfort zone, like skydiving, for a little thrill. I’m not an adrenaline junkie interested in the ultimate adventure nor an aspiring actress hoping for a guest appearance on SNL. I’m a physician and a physician leader. Learning improvisational theatre wasn’t on my comprehensive, personal to-do list.

But I’m also a physician coach. I sense what others feel in the moment without interpretation or judgment. However, when I tried to turn the same discerning sage on myself, I was faltering. The voice of compassion that I once used during patient visits and that I now use during client sessions, is sometimes muted by an inner critic that tells me to keep self-awareness out of awareness. It is this voice that I wanted to stifle when I hit the submit button.”

Terri Malcolm is an obstetrician-gynecologist and founder, Master Physician Leaders.

She shares her story and discusses her KevinMD article, “How improv helps physician leaders.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today in the show, we have Terri Malcolm. She’s an obstetrician-gynecologist and a physician coach. She wrote the KevinMD article “How improv helps physician leaders.” Terri, welcome to the show.

Terri Malcolm: Thanks, Kevin. It’s really nice to meet you, and it’s really a pleasure to be here with you and your audience.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Terri Malcolm: Sure. As you mentioned, I am an OB/GYN, and I am also a coach, a physician coach. So I started off in medicine first. I knew as a very young girl, I can remember as early as six, that I wanted to become a doctor, and I was really on that path to becoming a physician and sacrificed everything and put everything towards just that single-minded goal.

Once I became a physician, I was always really interested in how decisions are made that impact the work that we do as doctors. And so I did transition into physician leadership, because I really wanted to make a difference and have a greater impact that could go to scale. I loved the one-on-one connection with patients, but I really felt like there was more that could be done to improve the quality of care that we were delivering.

In becoming a physician leader, I was introduced to physician coaching, and that is what really sparked my curiosity about how I can continue to take things to scale and how I can really help our physician community even more. So now that’s where I spend the majority of my time, working directly with physicians, partnering together with them to help them discover the greater potential that exists within.

Kevin Pho: Tell me how your background in training as a physician prepared you to be a coach.

Terri Malcolm: You know, quite honestly, it didn’t prepare me at all. I mean, becoming a coach was a lot of unwiring of some hardwiring that existed. It allowed me to move into a completely different sector, a completely different industry.

I mean, I think that where there is some similarity is in our level of curiosity. I absolutely believe physicians, we’re just innately curious about things. We’re innately curious about how the body works together, about how the signs and the symptoms that patients present with ultimately lead to a diagnosis.

Where I think that there’s a fork in the road is that as physicians, we’re really taught to come up with an answer. We’re really taught to evaluate, and then diagnose, and then treat, and then modify based upon the response to that treatment. So it’s a very clear cycle that we follow.

With coaching, there’s a lot of curiosity, but it’s not so much trying to find a solution. It’s helping the client, it’s helping the coachee, to determine what works best for them. So you’re much more of a partner, you’re much more of a guide, and it’s just following that curiosity a little bit longer, just remaining in that place of “I don’t know what the answer is. I’m holding back on the advice. I’m going to let the advice gremlin just stay quieter a little bit longer and just follow the curiosity to see where it might lead.”

Kevin Pho: So let’s transition into your KevinMD article, “How improv helps physician leaders.” Now, for those who haven’t read your article, can you walk my audience through it and share the story of why you decided to write it?

Terri Malcolm: I really just wanted to share my experience of stepping up onto the improv stage and just how that was so outside of my comfort zone, so outside of my norm, primarily because there is an inner critic that was telling me I couldn’t do it. And it was an inner critic that, I mean, even beyond just “You can’t accomplish this” or “You can’t do this”: “You’re going to completely embarrass yourself. You are just going to make a total fool of yourself. You’re going to fall on your face, and everybody’s going to laugh at you.”

That inner critic was one that would often keep me from following through on things that were really important to me, and sometimes from just taking the plunge, and it was holding me back. And so I thought, well, improv is a way to help overcome those perfectionist tendencies that I can lean towards when something is really important to me.

I personally have an executive coach who’s very familiar with improv, who had practiced this before, and he said, “I think that this would be a good idea for you.” I resisted multiple times and said, “I don’t think so. I can’t do this.” And finally, just over time, he just kind of massaged that fear muscle, and I said, “I’m going to give it a shot. I’m going to try.”

Improv really allowed me to be mindful, to be in the moment, focused in the moment. I was not focused on what had happened, what transpired, criticizing myself for how things went, or if things went well or if they didn’t go well. Nor was I so focused on the future and how all of this is going to work out, and “Oh, this is so uncertain, and I don’t know where this might land.” It just really allowed me to be present in the moment, fully supported by other castmates and other improvisers on the stage with me who said, “I’m here with you, and no matter where you land, we’re all going to land together, and we’re going to pick one another up, and we’re going to work through this together.”

Kevin Pho: Now, a lot of us see improv on television, but what are some of the specific exercises that you went through on stage that may have helped physician leaders who are practicing out there?

Terri Malcolm: Yeah, you know, I’m glad that you’ve seen things on TV, because that was honestly one of the things that kind of made me paranoid. I thought, “I don’t want to be on ‘Whose Line Is It,’ you know, ‘Whose Line Is It’ next. I don’t have any aspirations to be on ‘Saturday Night Live.'” And those are really the professionals who are on stage practicing improv.

But just some of the simple exercises that we would do is even building a story together, just building a story together and doing it one word at a time, so that everybody had an opportunity to make a contribution and everybody’s voice was heard and everybody really felt valued. And you couldn’t be the whole storyteller, so you couldn’t try to steer or guide or direct the story in any certain way, because your contribution was only one word.

So one of the lessons that I learned within improv was “Bring a brick, not a cathedral.” So you don’t have to have all the answers, and you don’t have to try to bring the whole cathedral for everybody to then be in awe of or to pick apart. Just make one single contribution, and if that’s in one word, do it in such a way that it keeps the story going, so you are making your castmates look good. Because, you know, another one of the basic tenets is “Make your partners look good.” So it’s not about you trying to shine, but making sure that you’re supporting your partners and lifting them up as well.

Kevin Pho: How can you specifically apply that to the exam room? So I have a general idea based on what you said, but I’d like to hear from you. What are some specific improv techniques that a clinician can use in the exam room with a patient in front of him or her?

Terri Malcolm: I think one of those questions is really, “What can I notice here?” So it’s really being in tune to what the patient is telling you. And so when you ask a question, it’s pausing and really listening to what the patient is saying, listening beyond just the words that the patient is telling you, but paying attention to the emotions that are behind the words, paying attention to the nonverbal body language that the individual is sharing with you.

And I think it’s just the same with physician leaders as well. Even when you’re in a meeting, what are people telling you that they’re not really vocalizing verbally? And so I focus on “What can I just notice here? What are some observations that I can make in this interaction between the two of us that I may not otherwise have noticed before?”

Another is definitely “What can I even accept here? Am I holding on to my own agenda? Am I holding on to my own thoughts of what the diagnosis absolutely is prior to really giving the patient an opportunity to share with me what they think is going on?”

I think, as I said before, we’re definitely hardwired. We’re programmed to really come up with an answer, and patients are coming to us for our level of expertise. That’s what they’re looking for. They’re not wanting us to direct them, “Just go look at a website or go read a book and figure it out on your own.” We have the knowledge base, we’re well-trained, and we want to be able to share that expertise and that knowledge with others so that they can most certainly lead healthier lives. But sometimes I think that our desire to share the answer and our desire to share our knowledge can interfere with our ability to receive additional information that others might be trying to tell us.

Kevin Pho: Now, related to improv is acting, and I’ve had some recent articles connecting bedside manner with acting. Now, I just want to ask, from your perspective, is there a connection between acting and doctoring? Do more physicians need to be actors in the exam room?

Terri Malcolm: Gosh, great question. I don’t think I had thought so much about what it’s like to be an actor in the patient exam room or at the patient bedside. But I do think that one of the things that improv really helps you with is spontaneity and uncertainty.

And most certainly in the patient-physician relationship, there’s going to be a lot of uncertainty, and you definitely have to be able to just go with the flow. You have to be prepared for that unexpected moment when maybe the treatment plan doesn’t go according to the plan. And you’re like, “Everything should be following, because it makes sense for it to follow according to the plan,” but it doesn’t. Or something has just been said to you that is quite shocking and kind of just throws you out of your state of normalcy.

So I think that there are certainly applications that we can use of just being more comfortable with that sense of spontaneity, and being mindful about what really triggers you and what does excite you and what energizes you in the same manner that you’re interacting with your patients.

Kevin Pho: We’re talking to Terri Malcolm. She’s an obstetrician-gynecologist and a physician coach. She wrote the KevinMD article “How improv helps physician leaders.” Now, if physicians are interested in taking that next step and going to formal improvisation classes, what’s your recommendation in terms of advising them for the next step?

Terri Malcolm: Yeah, well, I think one thing I would start with is just the “yes, and” challenge. “Yes” is really the bedrock of improv. And so the “yes” is really underscoring acceptance. It’s honoring, it’s acknowledgment, it’s encouragement. It does not mean that you agree, but it just means that you really are acknowledging what the other person has said. So it’s really about listening to the other. And the “and” is punctuating the building and the extending and the supporting and the connecting. When you put those together, you are listening and then adding.

And so I would encourage everybody just to start for a week and look at “Where can I yes-and?” And you might be surprised at how much your initial response might be no. But if you could just start by responding with a yes, again, it doesn’t mean that you agree, but yes to just be a little bit more curious and see where the conversation might go, so that you’re acknowledging and honoring what the other person has said, and then you can build upon that and just kind of follow that.

Just give it a shot. You can try it with your spouse, you can try it with a colleague, you can try it with a patient, a practice manager, even with your kids. Just see what it’s like, instead of instinctively responding with a no, to respond with a yes, and.

And then after that week, just kind of reflect a little bit on “What did I notice about my interactions with those where I yes-anded? What did I accept? What was I more willing to accept? What did I need to let go of in those interactions?” And then you can continue to apply that and keep trying.

And I mean, I think if I could be an example for anybody who can really get over the fear of the unknown and the fear of what might happen, that it could potentially go wrong, and just let that inner critic kind of be a little quieter, and instead look at the inner critic as “How can you be a friend to me, and what kind of information are you actually trying to give to me so that I can move forward?” then, you know, try improv a little bit. Just try something that’s out of your comfort zone, and, you know, I’m happy to explore that along with you.

So, you know, this is what I love doing. I absolutely love helping physicians to create a new change and break some old habits and find ways to approach things that they’ve never done before. And “yes, and” in improv was one of those. Leadership let me do that.

Kevin Pho: And my final question, Terri: What is your take-home message you want to leave with the KevinMD audience?

Terri Malcolm: What I wish that I had known before I really embarked on my whole physician career was that failing forward is really about leveraging your mistakes. And so I think if I had really understood what it meant to fail forward, and that it was OK to fail forward and really be encouraged to do that. I had just a very kind of monolithic, I think, view of what failing was. But improv really helped me to see that failing forward is about living with the downside, experimenting with new approaches, and it’s investing in human resources. So there’s nothing wrong with investing in yourself. It’ll be the best investment you ever make.

Kevin Pho: And how can people reach you?

Terri Malcolm: They can reach me at my website, which is Master MD Leaders. I’m also on LinkedIn, and I’m on Instagram, but it’s all under Master MD Leaders or Master Physician Leaders. I’d love to connect. I’d love to get to know you and share your stories and your “yes, and” challenge experience.

Kevin Pho: Well, thank you so much for sharing your insight, and thanks again for being on the show.

Terri Malcolm: Yeah, thanks, Kevin.

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