Dr. Liisa Bergman is frustrated. She’s spent the last 20 minutes trying to coax information from Rita Barron, a stylishly dressed patient who has come into Bergman’s internal medicine practice complaining of headaches. The large purplish bruises under Barron’s left eye, along with an X-ray of her left forearm revealing a “nightstick trauma,” a defensive wound common to victims of domestic abuse, make the young doctor fear for her patient’s safety. But Barron says her injuries are due to a recent car accident, which no one else witnessed.

“Alright, time out,” Bergman finally yells, exasperated. “What do you do when you know your patient is totally lying to you?”

The question’s not rhetorical; it’s meant for her classmates. If Rita Barron were not really Renee Featherstone, an actor wearing makeup and an arm sling, how would Dr. Bergman, a first-year medical student in a Doctoring 1 module on domestic violence at UCLA’s David Geffen School of Medicine, ensure her safety? How would she tell the frightened woman she’s required by law to report abuse injuries, knowing that Barron’s husband is an LAPD detective? Co-instructors Angela Jo M.S. ’03, an assistant clinical professor at the Geffen School of Medicine, and Geri-Ann Galanti ’72, M.A. ’76, Ph.D. ’81, a medical anthropologist at California State University, Dominguez Hills, respond that with an evasive patient (Rita Barron is based on a real-life case study), the direct approach may be the only option.

A shaky Bergman nods and looks around the room. She takes a deep breath. “OK, time in,” she says, gesturing to her patient. “Rita, I know this can be very hard to talk about. … Has your husband ever hit you?” No one makes a sound. Tears stream down Barron’s face. Bergman reaches for a Kleenex and inches closer. “Sometimes,” her patient whispers. “Sometimes.”

Past generations called it “bedside manners”; current ones prefer “compassionate medicine.” By any description, Liisa Bergman, Andrew Nguyen ’05 and Naeemah Logan, who all donned white lab coats to interview the fictional “Rita Barron,” are being taught how to bring humanity to a volume-oriented system that’s badly in need of it. Susan Edgman-Levitan, executive director at the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital and co-principal investigator of the CAHPS program, which provides widely used patient feedback surveys, insists that “the strongest driver of overall patient care, in any setting, is doctor-patient communication.”

In that noble effort, UCLA is ahead of the curve. Almost 20 years ahead.

Standardized patient interviews like the one with “Rita Barron” first appeared in UCLA’s medical school curriculum in 1990, as part of an empathy-building concept called Doctoring. The goal was simple: Teach students to rely on interpersonal skills as much as they do on lab reports and CAT scans. The format was revolutionary: Break students up into small teams, led by one physician and one mental health professional, and role-play what doctors really go through in their day; i.e., delivering bad news.

“Give the diagnosis in understandable terms,” counseled a physician’s assistant at a grief counseling center in West Los Angeles, during a role-playing session in which one Doctoring student played the doctor and another played the patient. “‘The lump is malignant. … It is cancer.’ Provide hope, tolerate silences and don’t be afraid to be a human being.”

Drs. Michael Wilkes Ph.D. ’92 and Stuart Slavin started the first Doctoring program at UCLA 17 years ago. Ken Shine, then dean of UCLA’s School of Medicine, had asked Wilkes, a former ABC News reporter, to retool the clinical curriculum. Slavin, who headed UCLA’s pediatric residency, and Drs. Jerry Hoffman, head of emergency medicine, and Richard Usatine, who oversaw family medicine clerkships, were young practicing doctors, eager for change.

“We had no template for a program that stretched across all four years and was not department-owned,” notes Wilkes, now vice dean at the School of Medicine at UC Davis. “We literally started from scratch, writing everything based on our own case studies.”

Radical as it was, the new Doctoring curriculum stood the test of time. It has since been exported to medical schools in the United Kingdom, China, Brazil and around the U.S. “The biggest trend [in medical education] is cultural and social sensitivity,” says Jay Bhatt, president of the 68,000-member American Medical Student Association. “Schools like UCLA, which put cultural competency issues into their curriculum in a meaningful way, are at the cutting edge.” (Indeed, the group’s Teacher of the Year award this year went to Dr. Christian de Virgilio M.D. ’86, a professor of surgery at the David Geffen School of Medicine.)

Dr. Susan Skochelak, senior associate dean for academic affairs at the University of Wisconsin’s School of Medicine and Public Health, adds that when UCLA leads, others follow. (Along with Wisconsin, UCLA was among only nine schools to receive a recent NIH grant to change medical education.) “We all look to UCLA’s curriculum for ways to be more innovative,” notes Skochelak. “Their Doctoring program was the first to define core sets of skills [in medical education]. It used to just be about taking a test and us saying, ‘too bad if you don’t know the answer.’ UCLA developed team learning, where doctors help each other to find the answers together. That’s how we practice medicine today.”

Dr. Susan Stangl M.D. ’77, associate professor of Family Medicine, is chair of the first year of Doctoring/Clinical Skills, at a time when students are most receptive to the precepts of compassionate medicine. Stangl, who says her medical education in the 1970s consisted of “labs, lectures and studying,” was terrified the first time she had to tell a patient he had cancer. She says UCLA’s Doctoring program can instill skills — like learning to deal with the grief of a patient’s family — that can change careers.

Two years ago, for example, Nikita Bezrukiy M.S. ’01, a lanky UCLA medical student from Ukraine participating in the Doctoring program, shadowed Chaplain Irene Aiko through the Pediatric Intensive Care Unit. Reverend Sandra Yarlott, director of Spiritual Care, had warned Bezrukiy (now a third-year student) about the process. “You’ll see some extremely ill people; perhaps be present at the death of a patient. If you approach the bedside, a family member may take your hand in prayer.”

Bezrukiy’s first stop was a bubbly 9-year-old girl from Bakersfield named Cory, who had been waiting three months for her second heart transplant. As he listened to the child’s mother recount her harrowing medical history, Bezrukiy never looked at the girl’s chart or mentioned her failing heart, even though he had already amassed enough clinical skills to know what lay ahead. Mostly, the young doctor made reassuring small talk and allowed Cory to beat him soundly at her favorite video game.

“In cases where the prognosis is not hopeful, the doctor’s personality is more key than their personal religious beliefs,” Aiko told him. “We lost 19 children in November and December, and they [the doctors] detach emotionally as a defense mechanism.” Bezrukiy, who grew up under communism, says he does not have strong religious beliefs, yet would have joined Cory and her mother in prayer if asked. “Shadowing chaplains shows the limitations of medicine and how other members of the team fill in the gaps,” he says. “For me, the Doctoring program is a bridge to those gaps: How will I present myself to my patients beyond just medical answers?”

That’s a worthy question to ask. And no one doubts that communication is good for patient safety. But can being more compassionate really improve clinical outcomes? Even UCLA’s brightest medical minds say the intense time pressures of today’s health-care system can mitigate the human touch instilled by Doctoring instructors, who are all professionals working as unpaid volunteers. The question is a slippery one: tracking Doctoring graduates, who migrate to residencies and clinical appointments around the country, for follow-up data is like medicine itself, more art than science.

“If we see it as a bell curve,” explains Wilkes, “15 percent of the students are born to doctoring, 60 percent learn and love it and it goes on to change their practices, and 15 percent, we could use chisels and hammers, and still not make a difference.”

Third-year student Rakhee Goel says she’s in the 15 percent that’s hard-wired for Doctoring — but she was also inspired. Goel attributes her and her peers’ receptivity to the program to a generation that fosters a more open-ended view of healing, given so many more diseases with social determiners (like hypertension or diabetes) and so many more patients with different cultures and beliefs.

“Can you be a good doctor with only traditional training?” she asks. “Absolutely. You can be brilliant. Can you have a long-lasting impact in your patient’s lives? Not in my view. That’s what the Doctoring program is all about.”