Munson Healthcare’s newest partner is going to surprise you.

Last year, a pair of physicians at Munson set out to help their colleagues improve at one of the most stubbornly difficult parts of the healthcare profession: delivering bad news to patients. That goal led Munson to strike up a partnership with Old Town Playhouse, melding medicine and theater for an innovative course that gives doctors a chance to practice difficult conversations. The doctors play themselves, informing patients about challenging or terminal diagnoses. The Playhouse actors play the patients, reacting differently depending on how their physician approaches the conversation.

According to Dr. Roman Barraza, Munson Healthcare's director of hospice and palliative medicine, the improvisation-heavy scenarios help doctors work out the flaws in their bedside manner. The goal? When the time does come to share news of, say, a terminal cancer diagnosis, Munson’s physicians have the tools to approach that conversation with sensitivity, empathy, and humanity

For Dr. Barraza, difficult conversations are already central to the job description.

“A lot of what palliative medicine focuses on is working with patients with serious illness,” he says, noting that he regularly works with patients with “life-limiting or life-threatening conditions,” like cancer, heart failure, advanced lung disease, dementia, Parkinson’s, or ALS. “A lot of our specialty focuses on us developing a skill set of communicating effectively during very difficult and emotionally heightened circumstances.”

It’s not just about telling patients they are going to die. In palliative medicine, Barraza’s job also involves informing patients that treatment efforts aren’t working and it’s time to reassess strategy. Those conversations are crucial, he says, because patients often have differing views on how to approach continued medical care. Some want to exhaust all options for prolonging their lives, no matter the cost or consequence. Others forgo riskier or more invasive treatments to spent more time with the people they love. In either case, the patient needs to make a decision – and needs all the information in order to do so.

“90-95 percent of general patients will say, ‘I want my physicians to be very honest with me, even if it's not information I want to hear.’” Barraza says. “As a result, if you survey physicians and clinicians, the vast majority of them will say these are conversations we need to be having. Yet, only about 15 percent of doctors acknowledge that they actually have these conversations.”

Why the discrepancy? The big reason, Barraza tells The Ticker, is that medical schools “typically don’t train” physicians on how to have the challenging conversations. Barraza’s colleagues will even call upon him to get involved in their tougher cases, just so they don’t have to deliver bad news on their own.

In 2023, Barraza teamed up with fellow Munson palliative physician Dr. Bilal Malek to bring a crash course in difficult discussions to the healthcare system. Similar to Dr. Barraza, Dr. Malek says he's noticed “a lot of gaps in communication skills for primary providers and specialists alike when caring for patients with serious illnesses.”

The pair set about bringing a program called VitalTalk to Traverse City. Described on its website as “the premier training organization for clinicians seeking to advance their communication skills,” VitalTalk creates “simulated patient experiences using trained actors playing the role of the patient,” Malek explains. “The goal is to let doctors practice the communication skills of sharing bad news, talking about a person’s values and what matters most to them, and discussing complex decision-making around medical care.”

Barraza and Malek are both VitalTalk facilitators, enabling them to lead sessions here in Traverse City. They hosted their first pilot session in September, working with Old Town Playhouse to recruit four local actors to play the patients. In April, they’ll host another session.

Speaking to The Ticker, two of the four actors – Clover Keyes and Eldon Horner – say they jumped at the opportunity to use their theatrical experience in such an innovative, helpful way. Keyes is a lifelong theater performer, having studied acting at New York University's Tisch School of the Arts. Horner found his way to the craft later in life, but is now a regular on the stage at Old Town Playhouse. Both dove headfirst into their characters – patients about to receive terminal cancer diagnoses – but approached the roles in different ways.

“[Munson] left it up to us to decide what kind of emotion we wanted to play, and my approach was just pure despair,” Keyes says. “I thought about my own kids, and I thought about my partner, and I though about how I would feel leaving them behind. And then I just cried all day.”

Horner, meanwhile, went for rage.

“For me, the anger came out; the disbelief, the disconnectedness of it all,” Horner says. “My character ends up feeling like he’s a just a statistic, somebody to be shunted aside. ‘Now you're off to hospice. Now you're not our problem anymore.’ And thinking about that pissed me off.”

For Keyes and Horner, a challenge of the work wasn’t just playing the extreme emotions of their characters, but also modulating their responses depending on how each doctor approached the conversation.

“That’s where the improv comes in,” Keyes explains. “It's not a typical performance, where you have a script and can say, ‘Okay, I'm just going to be a sad woman now.’ Yes, I’m going to play this character sad. But, if the doctor says something very comforting and soothing and lovely to me – something that would make me feel better in real life – I'm going to let her know that she's making me feel better. Because that’s just as important to the training as her having to experience a sobbing woman.”

In the wake of the first session in September, Barraza says he’s received strong feedback from the doctors who participated. The response has been especially positive from the contingent of physicians currently completing their residency at Munson Medical Center. Those young doctors will still call him to assist with difficult conversations, but there’s been a subtle shift in how those interactions go.

“I’ll get a call from a resident and they’ll say, ‘Hey, I'm going to see this patient, and it's going to be a difficult conversation, and we want to consult you for your expertise,’ Barraza says. “But they’ll also say, ‘I really want to be there with you. I want to join you for this conversation, so I can learn.’ So, our residents definitely seem much more motivated and engaged around this topic now than they did before their VitalTalk session.”

Pictured: Three of the four OTP actors (Eldon Horner, Clover Keyes, and Terri Hefron) and Dr. Roman Barraza, Medical Director of Munson Healthcare Hospice and Palliative Medicine.