Unscripted | Episode 3

Healing with Humor: Dr. Mike Smith’s Improvisational Healthcare

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Doctor Mike Smith believes that improv can help improve communication in healthcare

Addisyn Uehling: Welcome to Unscripted. I’m your host, Addisyn Uehling. On, today’s episode, we will be sitting down with Doctor Mike Smith. Doctor Smith is a member of the healthcare improv team and has years of experiencing, practicing, performing and teaching improv through Omaha’s backline comedy theater and around the country. Doctor Smith’s belief is that improv is a valuable tool for helping improve communication and make life more joy filled. Realizing early on that his skills learned through improv could help him as a hospitalist, Mike began implementing those around work. The result was more enjoyable work, better interactions with patients, and more effective teaching. Join us as we explore the seemingly unlikely pairing of improv and healthcare on today’s episode of Unscripted. Well, thank you so much for joining us today, Doctor Smith.

Mike Smith is an academic hospitalist at the University of Nebraska

can you start by introducing just yourself and kind of telling us a little bit about you?

Dr. Mike Smith: Sure. So, my name is Mike Smith. I’m an academic hospitalist at the university of Nebraska. I also teach, perform and watch improv at the backline theater in Omaha. And then I run a website called healthcareimprov.com. That is my thoughts on the blending of those two worlds.

Addisyn Uehling: Awesome, awesome. Well, what inspired you to go into the medical field?

Dr. Mike Smith: I would have to say my family, they, all my siblings are ten or 1910 to 19 years older than I am, and so I got to see what they did with their lives and got to kind of pick and choose. And I had a brother that’s a lawyer, and I have a brother that’s a doctor, and I was always kind of more into math, science, that field, and so that’s the route I chose.

Addisyn Uehling: Cool. So what kind of made you choose your specialty?

Dr. Mike Smith: Yeah, so my brother that is a doctor, he’s a radiologist. And so I was kind of marching down that path because it seems he enjoyed it.

Addisyn Uehling: Yeah.

Dr. Mike Smith: it is not my personality at all, though. So, I went with internal medicine because it suits kind of my strengths.

Addisyn Uehling: Okay. Okay, awesome. That’s super cool.

Medical improv falls under the umbrella of applied improv

So you say, you do medical improv, kind of. What is that? Can you explain that to the audience?

Dr. Mike Smith: Sure. So medical improv falls under the umbrella of applied improv. And so that’s taking the skills, exercises and practices from improv theater and then applying it to a new context. And so improv theater, is anything that’s made up on the spot. It got its start in America, at least in the early 19 hundreds. in Chicago, there’s a woman named Viola Spolin who did it with immigrant children and played games. And so it was a way to help them, integrate into society in a way. And then her son, kind of pioneered the idea of using it as a way to build material for scripted, productions. And then eventually it became, people, want to watch the process happen. And so it’s kind of taken those various forms, since then. And medical improv is basically going back to those games that viola spolin, started and using it to kind of build creative ideas and creativity and a lot of the communication principles that are so essential to medical practice.

Addisyn Uehling: Yeah.

My wife got me improv lessons for Christmas one year

What kind of sparked your interest in improv?

Dr. Mike Smith: Yeah, so it was kind of sparked upon me, if that makes sense. my wife got me improv lessons for Christmas one year. Prior to that, I never had any theater experience. that Christmas, we had just moved back to Omaha, and I lived in new, we lived in New Orleans at the time. And I didn’t really want to move back to Omaha despite us both being from here. But I was outvoted and so I tore my ACL as well. My main activity prior to that was playing sports, and that was kind of taken away from me. I was kind of, mopey about moving to omo. It was great that I did. I was very happy with it, but at the time, I was not seeing the light. and so that Christmas, she got me improv lessons and I kind of just started doing it. And I didn’t really tell anyone at work that I was doing improv. I kind of was a little shy about it. Then, I started doing some of the skills from improv class at work, which a lot of people give me a weird look when I say that. It wasn’t like I was taking patients out into the hallway and making them do stuff with me. It was more the skills practiced in improv class. How do I practice that skill at work? And so, there’s an exercise called a three line opener where you come out on stage without knowing what you’re going to say. M and the other person doesn’t know either. So within three lines, you kind of have to establish who you are with each other and go from there. my patients in the hospital are in kind of a similar position in that they’re vulnerable and they meet hundreds of people and they don’t know who this person is versus that person is. And so if I really focused that start of the conversation on connecting with them, on what’s important with them and what, what my role is, that just made all of our interactions go much better, starting from that place of connection. And as I was doing that, my patient satisfaction scores improved more than anyone else in my group. So I was like, yeah, look at that. and so I was very excited about it, but I was also kind of like, well, I thought I was good at these skills already. And so just that awareness of practicing those skills, the improv stage made me practice it in my job and then gave, me opportunities to seek continued improvement.

Addisyn Uehling: So it’s kind of like a great training aspect almost, to learn the skills and then to be able to apply them into your situation. Does that sound right?

Dr. Mike Smith: Yeah, that’s exactly right. There’s a guy named Eduardo Brinseno who has a TED talk. it’s titled how to get better at the things you care about. In it, he talks about performance, zone and the learning zone. And as physicians and pretty much anyone in the healthcare field, you spend all of your time in the performance zone. And so there’s not really a good opportunity to take a risk or get better at these skills. and you only have these big, seminal moments that serve as learning points, as opposed to the improv stage, which is very much a learning zone, feels high stakes. Most people kind of get antsy about it. so it has all the feeling of high stakes, but it’s actually very low stakes. And so you get to practice those skills of connection, communication, listening, in an environment where there’s no actual consequences.

Addisyn Uehling: Yeah, yeah, that’s super cool.

Do you feel like improv helps improve communication between medical professionals

So how do you feel like a resident or fellow could like, or apply this to their life?

Dr. Mike Smith: Yeah. So there’s varying levels of improv training, and I think they all help. And no matter where someone’s at, I think it could, benefit them. The big rule or idea of improv is saying yes. And, and so that, it’s just two words, but it has big implications, in my opinion. And so the idea of saying yes to a person or a situation can be a lot more challenging than it would seem. and kind of suspending your beliefs just for a moment to try to understand another person can, be very difficult or challenging or not at the front of mind in the busy life of a resident or fellow. and then also the and part is very important because you have to add to that reality. And so it’s not just doing whatever whoever you’re talking to says. It’s not like you have to go around and, do whatever people say. It’s, you’re saying yes, that is that person’s reality, and you’re adding to it, in a way that you create a reality together.

Addisyn Uehling: Okay, awesome. Do you feel like communication, this helps improve communication skills between medical professionals?

Dr. Mike Smith: Yeah, yeah. so every medical professional and then even within physician specialty, they all have a different perspective and it’s inculcated in their training. and so just that step two, I want to understand your perspective. To get the best result for the patients can really, allow both perspectives to thrive in service of what’s best for the patients or what’s the team’s mission.

Addisyn Uehling: Yeah. So, like, higher communication levels, do you feel like there is a way to respond? This helps in high, pressure situations within training or attending?

Dr. Mike Smith: Yeah. So that’s kind of the main, main thing that I push in the improv workshops that I run. That improv training, especially medical improv, is not about making you funnier. It’s not about, turning introverts into extroverts or changing people in any way, shape or form. It’s, also not about teaching, people to laugh at serious situations. there’s a quote attributed to an ancient greek man. we don’t rise to the level of our expectations. We fall to the level of our training. And so in those high pressure situations, when you need these high stakes skills, it’s not going to magically come to you because you want it to. It’s going to come to you because you’ve practiced it. So far. Improv is the most fun way I’ve found to practice those skills.

Addisyn Uehling: Yeah, for sure. That’s super cool.

Do you have any examples of how improv has come in handy for you

Do you have any examples of how you’ve used it or how it’s come in really handy for you?

Dr. Mike Smith: Yeah, yeah. endless. I could talk for the rest of the day, but I’ll keep to a few examples. And so I work with a team of medical students and residents, in the hospital. And so just building a team atmosphere, the idea of. Yes, and, and understanding everyone and appreciating everyone’s input, again, to increase the educational environment. I think improv has been essential in helping me do that as best I can. And then when I failed, it’s also helped me to figure out how I failed and to get better.

Dr. Mike Smith: And then there’s also a patient one time that, came in for back pain, and there were some things on her chart that said she may have, opioid substance disorder. and so, kind of coming into the room, I was expecting a discussion about not prescribing opioids and maybe something confrontational. And I applied the principle of yes, Ian. So I had to understand her reality that she was in a lot of pain. And then I had to add my, part to that, which was, I do want to control your pain. And so I just listened to her. and I responded in a yes and way. And she’s like, yeah, okay, you listen to me, so we’ll go with your plan. And I was like, oh, okay. And so it took, something that may have been a contentious encounter into something that was very positive, and she trusted me and the team more, as a result of using those improv principles, that I didn’t come into the encounter to say, I’m going to listen to her, and I’m going to. Yes, and her. It’s just that I’ve been practicing improv, so frequently that I think it’s raised my baseline starting point. So I’m not perfect by any means, but it definitely helps.

Addisyn Uehling: It definitely helps, yeah, definitely.

Have you encountered any challenges, um, with using medical improv

Have you encountered any challenges, with using medical improv?

Dr. Mike Smith: Yeah. So I’ve encountered challenges both within myself. as I said, I didn’t really tell my coworkers that I did it because I was. I don’t know what I thought is kind of a different hobby for a professional, admittedly. And so when I first, in a public setting, told people that I did improv, and I’m using it to help me as a physician, that night, I was like, oh, God, what have I done? They’re all making fun of me. and so overcoming that kind of inner challenge has helped me, kind of be more confident, to get the idea out there. And then also kind of interpersonally with teams, there are people who are hesitant that will say, oh, I can’t do that, or, I’m not. This, that or the other thing doesn’t, apply to me. And so that’s, certainly a challenge that I, as I said, I kind of had similar experience. My initial thoughts on that, and so that’s, something that I think can be overcome. And once people see that there’s, joy and laughter, at the end of it, and, putting yourself out there is worth the effort that can be overcome. And then organizationally, like, trying to put on improv experiences for other healthcare professionals that, there are kind of three groups of people that I interact with. They’re the people who are automatically on board. They’re like, yes, I love improv. That sounds fun. I need. I have needed those people, and there are a lot of them, at UNMC, who’ve kind of supported and said, yeah, let’s do this. There, are also people who are like, no, absolutely not. Under no uncertain terms will I ever participate that, and I appreciate them and don’t, fault them for that by any means. the majority of the people are in the middle, where, they’ll say, yeah, we can do it, but what’s the proven benefit? Or can you show me how this has been, done at other places? Most of the people are in there and having. I’ve had enough of those conversations that it’s really helped, hone what I do, or in each improv experience to make sure that people will, if they’re in that middle camp, they’ll go over there. And even some of the people who are in the no, never camp, maybe they get to the well, if you show me camp.

Addisyn Uehling: Yeah, absolutely.

Do you think improv aligns with patients centered care in healthcare

So, how do you feel? Like the principles of medical, improv kind of align with patients centered care?

Dr. Mike Smith: Yeah, I, think it’s a way to practice true patient centered care. I think there’s a study in JAMa that said hospitals, with the highest patient satisfaction score, actually had a higher mortality and more expensive costs. And so that, to me, is not necessarily care. And then kind of what we think of more the paternalistic style of medicine, I think that has a whole host of bad things associated with it. And so, to me, patient centered care is literally saying yes, and to your patient, where you’re saying yes to whatever their reality is, and, even if you don’t agree with it, you can understand it. And then that sense of care comes from what you add to it, and so you’re building upon their reality, and so you make reality together. So, yes, and is a way to make sure that the patient is at the center of your care decisions and you’re providing your expertise, that you’ve spent all those years developing.

Addisyn Uehling: Yeah. So, basically, if you had a room full of residents or fellows, what would you want them to take away from this whole time?

Dr. Mike Smith: Yeah. The biggest thing that improv has helped with is the idea of yes, and. And in improv, they say there are no mistakes. And so that’s not necessarily true in the healthcare field. There are definitely mistakes, and there are mistakes in improv, too. It’s kind of what’s done after the mistake happens. On an improv stage, making a mistake is an opportunity to have fun. A lot of times, it’ll take a scene somewhere even more interesting or more fun, and mistakes in healthcare are bound to happen. And so the way that we’re educated. It’s all multiple choice tests and we’re graded on very fixed, games, so to speak. They’re winners, they’re losers. but once you get out into practice and residency fellow, it’s much more, having a conversation, being with someone, being present and using all those things from your education. but it’s more of a. An infant game to keep getting better and keep improving. And so the idea that there are no mistakes can be challenging, but, based on how we’re educated. But I think that makes a career in medicine fulfilling, because you can keep trying to grow and keep learning and keep improving, as opposed to seeing a mistake as a fatal flaw or something where you’ve completely failed, for sure.

Can you talk a little bit more about your workshop and how our audience can benefit

Addisyn Uehling: so you kind of mentioned the. Yes, and quite a bit. and that’s such an applicable thing that you can do, in your everyday life as a attending physician, can you talk a little bit more about your workshop and how our audience could find, some of your resources that could help them apply the medical improv to their daily life?

Dr. Mike Smith: Sure. so my website is healthcare improv.com and that just has all the, offerings that I do as far as workshops, that I’ve done in the past. But what’s most exciting to me is putting together a, ah, unique workshop for someone’s or a group’s unique needs, because everyone kind of has a different idea of what they expect. Some people want more funny laughter kind of a wellness type experience, and some people want more of this communication or leadership, experience. And so that’s on the website. And then all my social media has, a little more day to day updates and I think most of them are aged care improv for the handle.

Addisyn Uehling: Yeah, we’ll definitely put that in the link below. and then. Yeah. Thank you so much for your time. Do you have anything else you’d like to add?

Dr. Mike Smith: No. If, you’re thinking about taking an improv class, say yes. Go for it. it was thrust upon me and, it’s been one of the best decisions, or my wife’s best decisions. And she regretted it initially because I was constantly doing improv. And so she’s like, you’re off to improv again. But once she saw how much it helped me and helped me as a communicator, she’s now back on board.

Addisyn Uehling: So awesome.

Dr. Mike Smith: She’s glad she got me the gift.

Addisyn Uehling: Yeah. Well, thank you so much again for your time. And, I think that’s all we got. It wasn’t super long.

Mike Smith is training for the Ironman this year in Malaysia

Did you have any other questions you wanted me to ask? I was going to dive into you talked a little bit about your athletic accomplishments, but I didn’t know. I didn’t put those in the question, so I didn’t know if you were prepared to talk because weren’t you the one who’s trained for the Ironman?

Dr. Mike Smith: Yeah.

Addisyn Uehling: Okay. Okay. Yeah, that’s cool. How’s it going?

Dr. Mike Smith: good. It’s, far enough away that I can ignore it.

Addisyn Uehling: When is it?

Dr. Mike Smith: It’s October 12, and it’s in Malaysia.

Addisyn Uehling: Oh, wow. Of, this year?

Dr. Mike Smith: Yeah.

Addisyn Uehling: That’s not far away. That’s crazy.

Dr. Mike Smith: so I’ve done one on every continent except for Asia and Antarctica, obviously.

Addisyn Uehling: That’s cool.

Dr. Mike Smith: And I think there are, like, less than 50 people who have ever done that.

Addisyn Uehling: That’s insane. Yeah, you were telling me that. That’s super cool.

Dr. Mike Smith: And one of them’s my sister, so, yeah, now I have to.

Addisyn Uehling: Now you have to do it.

Dr. Mike Smith: Yeah.

Addisyn Uehling: That’s super cool. That’s super cool. What does that take? You were telling me about it. It’s like, what’s, like, the accomplishment? Like, you run, you swim.

Dr. Mike Smith: Yeah.

Addisyn Uehling: Like, what’s the miles?

Dr. Mike Smith: I guess, so you swim two and a half, roughly. You bike 110 miles and then run a marathon. So 26.2.

Addisyn Uehling: That’s insane. How do you train for that? Like, you just do it all at once?

Dr. Mike Smith: No, it’s a different type of training. So you just try to go longer, and you go slow and build up your aerobic capacity and.

Addisyn Uehling: Okay.

Dr. Mike Smith: So it’s a little bit different approach, and it’s kind of, I don’t know, the same thing as improv. Like, the idea of doing hard things.

Addisyn Uehling: Yeah.

Dr. Mike Smith: and the sense that. So I’ve done enough of them that I know I can do it, and I just gotta stick with it. You, get tired and feel like quitting and then proceed pushing up past when you feel like quitting. Yeah, I think is a good thing for me.

Addisyn Uehling: Yeah.

Dr. Mike Smith: Like, kind of the uncomfortableness.

Addisyn Uehling: Yeah, well, I was a swimmer, and swimming 2 miles. Yeah, I mean, I’d be done after 2 miles, so, yeah, this is the.

Dr. Mike Smith: Only one where you don’t get to use a wetsuit that I’ve done, and so wetsuits just keep you. The last one I did was in chattanooga, and you swim downriver. So it’s just, like, kind of casually super easy.

Addisyn Uehling: Okay.

Dr. Mike Smith: Yeah. But because of that, they added four extra miles to the bike, and by the end of the bike. My legs were cooked. M. No, I don’t know which is worse. The swimming. At least it was not. I think swimming against the current.

Dr. Mike Smith: Is much worse.

Addisyn Uehling: Yeah.

Dr. Mike Smith: but I think I would have preferred to no current and no extra miles.

Addisyn Uehling: Yes, yes. No, I agree. Thank you for joining us on today’s episode of Unscripted. Today we talked to doctor Mike Smith about how improv can be a useful tool in the medical field. If you enjoyed today’s show, please make sure you, like, subscribe and share so you’ll never miss an episode. I’m your host, Addisyn Uehling, and this is Unscripted.