Listening Between the Lines

One of the strengths of medical education at UC San Francisco is the opportunity to work with a diverse group of patients.

Carol Miller, MD

Pediatrics residents see families with roots in the hill country of Laos and the villages of El Salvador, families who struggle financially and those of means. Caring effectively for these patients requires finely honed communication skills, and pediatrician and neonatologist Carol A. Miller, MD, helps make sure that students who pass through UCSF Pediatrics acquire them.

Culturally sensitive communication is an essential piece of the core communications competency required of UCSF graduates, and Miller thoroughly enjoys helping residents and medical students build those skills.

“People have differences in their world view and in their past experiences, and providers have their own world-view biases,” says Miller, a soft-spoken woman with a calming presence.  

Miller began working with residents on this issue early in her 30–year career as a pediatrician, at a time when the concept of culturally sensitive training was just starting to bubble up in medical training. 

“It struck me as important here because of the diversity of the population at UCSF," she says. "It opens an opportunity for a more in-depth relationship, and increases how helpful you can be to patients.”

Miller uses a variety of teaching tools, including lectures, role-playing and clinical observation to help residents hone their communication skills. She builds awareness of the nonverbal ways that can help physicians work more effectively. What is the emotional atmosphere when they first walk into an examining room?

“If you notice what first hits you, it helps you modulate your behavior in a helpful way,” says Miller.

She encourages physicians to explore whether they give an impression of being patient or rushed. Are they making assumptions about the family constellation, such as marital status and sexuality? Do they greet the family? Talk to the child?

“It’s all about making the patient more comfortable,” says Miller.

Read more at the UCSF Department of Pediatrics website.