Class #4 - Informed Consent -Therapeutic Riding - B Kane, MD

Blinked and I missed it. This course seemed way too short. I will not again try to squish 24 hours of Medicine and Horses into 8.

That said, let me look back on what I learned in these 4 short classes. We teach that which we most need to learn and we attract those who need to learn from/teach us. We had a great group, and for the first time, mixed med students with a resident, a fellow, and a practicing physician. I really like how that worked out. I could look at each one and see myself in a different phase of my own development.

Now I am learning to stay out of the way more and let the experiential learning process be one of the person's own discovery. It's so tempting to think you know what's up with someone--including, or especially, your patients. It's so easy to get into a thinly-veiled directive of "fixing" people or trying to get them to see what you see in them. Fergeddabout it!

My gem from yesterday, and from the Oklahoma experience, was: all that pimping on rounds, all that Socratic methodology--it's all aimed at making the person wrong. One person pointed out that some attendings will pimp until they get the resident to come up with a wrong answer. Our way of using the Socratic method in M&H is to ask questions from a genuine place of curiosity about the person.

As usual, the horses brought out different things in different people. Amazing how differently they react! In our first exercise, "Informed Consent," students tried to get the horses to cross a crinkly, shiny, flapping space blanket--very scary for a horse! It's probably the horsey equivalent, in fear, of open heart surgery or a kidney transplant. Some students wanted to pet the horse into compliance, some took a more directive, get-over-it approach. There ensued an interesting discussion of where everyone was on the assertiveness scale. Not that one place on the scale is better than another--some patients will respond better to kindness than coercion. Some patients want the doctor to take charge. It's up to each physician to know w/here she is comfortable on that scale.

And don't tell risk management, but we -did- get the students up on horseback in a therapeutic riding model with sidewalkers. Extremely safe and instructive! That's the technique we use with TR patients--people with MS, autism spectrum, status post CVA, CFIDs.

I'm looking forward to Fall. We already have a couple of people waiting to take the class!