When Beverley Kane, MD, began teaching an elective course, "Medicine and horses: A communications model for the doctor-patient relationship," at the Stanford University School of Medicine, it was modeled after a University of Arizona medical school course. Students there had improved their patient interaction skills through the class.
The documentary, "Buck," chronicles real-life horse whisperer Buck Brannaman's story and approach to relationships between humans and horses.
Lea Steakley of Scope spoke with Kane about the course, now called "Medicine and horsemanship," which is based on Brannaman's techniques
Kane says horses are sensitive and pick up on every nuance of body language.
"They can even sense our emotions, especially when what we say is not what we mean or feel," Kane says. "In learning to notice the horse's responses, medical students are trained to become more aware of how patients respond, even when patients are too polite to raise objections in so many words."
She says the physical exam of the horse is one of the most popular sessions. Students approach the horse slowly and gently, checking on the horse's response.
As Brannaman uses the Natural Horsemanship technique, he draws upon these principles, whether working with horses or humans:
- Break the task down into smaller tasks that the horse [or human] can understand.
- Use pressure [ask] and release [reward for attempting the task] to teach each part of each task.
- Reward the smallest try, by release of pressure. Release by going to the last place the horse felt comfortable.
- Relationship is the most important aspect. "It is not the equipment or technique, it is the quality of relationship, feeling and communication."
"The horse's fear and resistance is a metaphor for patients who have to undergo scary procedures-anything from a simple phlebotomy (blood draw) to someone with needle phobia to major surgery," Kane says. "We know we can't get the horse through the scary thing all at once. If he even looks at it, we release the pressure and take him back where he felt comfortable. That way, we slowly gain his trust."
Leave it at the gate
Kane explains a crucial technique of horsemanship that students learn the first week of class—"Leave it at the gate."
"Every time a horseman works with a horse, and especially for that crucial five minutes in a horse show, he has to rid himself of all distractions—worries, physical annoyances, emotions, and anything else that would break his connection to the horse," Kane says. "Each week in the class, we state what we are leaving at gate so that we can we be fully present for ourselves, each other and the horses. … By analogy, we teach students that before they enter a patient exam room they need to take inventory of what they are leaving at the gate so they can be fully present for the patient."
One of the ways the course has changed through the years is an added emphasis on development of leadership.
"When I went to med school at UC San Francisco in the late '70s this was not something that was considered important," Kane says. "But now that most physicians are employees in large medical centers with hierarchical organizational charts, good leadership and followership are necessary qualities. Physicians must lead themselves, their patients, and their teams."
Watch this earlier video to see some Stanford medical students as they learn to interact with horses—and subsequently with patients.
Have you or physicians in your practice learned about interacting with patients using horsemanship techniques?