Medical student, Katalin Szabo, examines Apache
for telling signals of discomfort
It’s hard to ignore a patient who weighs 1,200 pounds, stands 7 feet tall and won’t hesitate to nip you if she doesn’t like what you’re doing.
But those attributes are precisely why medical students can benefit from working with horses, according to the philosophy behind a new elective course at Stanford Medical School, “Medicine and horses: A communications model for the doctor-patient relationship.”
Not intended for veterinary students, it’s geared toward making medical students more conscious of how they come across when interacting with others.
On the first day of course No. 252 at the Stanford University School of Medicine, a pack of horses were brought down from pasture near Portola Valley and herded into a corral, so the students could lean against the fence like wranglers and study … horses.
They were looking for both leadership and followership in the horse hierarchy, as indicated by ear pinning, tail swishing, nudging and nipping.
Dr. Beverly Kane with “Dream”
For many people, the idea of horses helping medical students hone their communication skills might conjure up images of Mr. Ed, the “talking” horse of TV fame, the bangs of his palomino mane flopping around as he tossed his head while lip-syncing to the soundtrack.
But Mr. Ed would have no place in this class, as horses who can’t speak the language are preferred: The point is to improve nonverbal communication.
Still, why don’t the students just stick to human beings?
“Animals in general respond to people in ways that are so transparent and honest,” said Sam LeBaron, MD, PhD, professor of medicine and director of the Center for Education in Family and Community Medicine.
“They hold up a mirror for students that they may not get from human patients.”
Beverley Kane, MD, added that just because patients can talk doesn’t mean they will. “Human patients don’t always tell you what’s on their mind,” she explained.
“We’ve all been socialized into hiding our feelings and reactions, especially from somebody in a white coat.
Horses will tell you in no uncertain terms how you’re affecting them—if you pay attention to the right signals.”
During every class, the students encounter a new horse, so just like a doctor with a new patient, the first task is always the introduction.
On one particular day, the task was to listen to the heartbeat. Kane said a common complaint is that doctors come at patients with a cold stethoscope, without taking time to establish rapport.
Medical student, Szabo, with her hand on the horse’s side, gently applied the stethoscope, sliding it down to the belly, behind the foreleg, to the heart.
After a few moments, she said she could hear the heart as well as a good amount of “digestive rumbling.” But the real measure of success was her patient’s calm—no ears laid back, no fidgeting, no walking away.
Fifth-year medical student, Tracy Dooley, said “I became a lot more conscious of how I behaved in certain situations. “What my body language would be telling a patient, or in this case what it was communicating to the horses, as opposed to verbal signals.”
But the class is about more than just making students aware of how their behavior affects a patient. Many medical students who don’t have experience dealing with horses are intimidated when they have to approach such a large animal, which LeBaron said is another thing of which doctors need to be aware.
“We want to become more mindful, as doctors, how we behave when we feel a little stressed or a little intimidated,” LeBaron said. “That’s something that virtually is never talked about, and the truth is doctors are as human as anybody else.”
Last spring was the first time the course was offered at the medical school. At the end of the session, Kane and the students hoped to see the class continue. It’s an elective and is completely supported by donations, so the future wasn’t guaranteed.
However, the latest word from Stanford University is that the classes have proven so popular and successful that the funding has been provided and the classes will continue.
So now, the lesson horses are on notice that herds of med students are about to stampede onto the ranch again.