At the end of her training as a young critical care physician, Rana Awdish, MD, MS, unexpectedly shifted from being a doctor to a critically ill patient when a mass in her liver ruptured during her pregnancy.
The rupture triggered a heartbreaking miscarriage, multiple surgeries and a series of life-threatening medical complications. In her first book, In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope, Dr. Awdish reveals how her own harrowing experience of loss, trauma and recovery led her to recognize how unintended communication barriers and missteps in health care can leave patients feeling powerless, alienated and fearful.
Today, as a pulmonary and critical care physician at Henry Ford Health, Dr. Awdish carries this personal experience with her every day. It reshaped her approach to patient care and drives her commitment to helping other physicians communicate more effectively with their patients.
Henry Ford Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“My own patient experience really showed me that we can do everything right technically. We can get the medical care perfect; we can make something that's unsurvivable survivable and we can give someone their life back,” she said. “But if we don’t attune to the unintentional harm that we can cause with our words, and if we’re not thoughtful about building relationships, attending to suffering and really acknowledging the grief in our patients, it’s an incomplete form of healing.”
Dr. Awdish believes this deficit starts with medical education, which focuses heavily on clinical skills while often overlooking communication training.
“It’s astonishing to me that I went through 14 years of postgraduate education where not a single hour was spent teaching me to deliver serious news, which is what I do all day,” she shared.
To help bridge this gap at Henry Ford Health, Dr. Awdish partnered with palliative care colleagues who were equally passionate about communication and launched the Connect, Listen, Empathize, Align, Respect (CLEAR) program in 2012. The program brings in improvisational actors from the Detroit area to help improve conversations between patients and physicians. The goal is to help physicians deepen their listening, initiate more meaningful dialogue with patients and colleagues, and encourage patients to be active collaborators in shared decision-making.
“It’s a way to build out our skillset,” said Dr. Awdish. “We're so good at the technical skills, and we’re so good at these procedures that are lifesaving. Adding this layer of compassion around all that makes it more complete care.”
In an interview with the AMA, Dr. Awdish shares why focusing on communication can improve patient care and physician well-being, while also strengthening trust and credibility across the health system.
AMA: You’ve said that communication is not just a skill, but a form of healing. How has this belief shaped your approach to improving communication among physicians at Henry Ford Health?
Dr. Awdish: Our communication work at Henry Ford is rooted in a foundational belief that communication is an essential skill to do your job not just well, but with longevity and joy. It helps physicians feel like they are having an impact and truly connecting with their patients, which is why so many of us go into medicine in the first place.
We want to be healers, rather than just people treating disease. The treatments are just one piece of it. It’s the relational aspects of care that feel like healing. Giving our physicians the tools they need to do that well is one of those rare interventions that help both the patient and the care team.
AMA: How does the CLEAR program help physicians at Henry Ford Health connect more deeply with patients and with one another?
Dr. Awdish: The goals of our CLEAR program are learning to listen actively, attuning for those moments in a conversation when expressing empathy is needed, and responding in a way that fosters a deeper connection. It also focuses on never giving a recommendation without first eliciting a patient’s values.
During the CLEAR program, physicians participate in small-group, experiential workshops where we give peer feedback. Doctors have an opportunity to try out phrases they might be unsure about using with real-life patients and families. By nature, we want to do good, we want to help, and we don’t want to fail.
Trying new things can feel scary to us, so we offer a safe, improvisational setting with trained actors where they might try a statement of respect like, “I’m so impressed by how you show up every day for your dad,” and just see how it feels to say this and how the family member reacts. A positive experience in the workshop makes them more willing to try something new at the bedside.
Then they also have their peers there supporting them and saying, “That worked really well.” All of that together changes what’s possible for these physicians when they return to clinical work.
AMA: What misperceptions or pushback have you encountered as you work to systematize this change?
Dr. Awdish: There are a lot of misperceptions that communicating differently takes more time, and we all know how pressed physicians are for time.
But there’s strong evidence that shows when we do this well, visits are more efficient. Further, our patients are less likely to come back with the same complaint, and they’re more likely to adhere to the medication plan that you co-create together. They can heal themselves and have more self-efficacy because they understand and feel heard.
The most important thing I hope people take away is that there is space for this. Taking the time to learn to communicate well will save you in so many ways. You won’t just be deploying treatments toward the disease. Instead, you’ll be delivering care to the whole patient and family.
AMA: How can institutions balance the need for productivity with meaningful human connection and care?
Dr. Awdish: We need to revisit our definition of productivity. I can get through an appointment efficiently in five minutes, but the patient won’t know what’s wrong with them or what medications to take. Then they’ll likely come back to the ER in heart failure because they don’t know how to manage their care. That’s not productive.
When we have a narrow idea of productivity based on the number of patients we see, how quickly we do it and how many we can see in a day, we’re depriving everyone of valuable and truly productive care.
A lot of the value-based care models that look at outcomes help us see how we are caring for the patients rather than how much are we “producing.” That approach is much more aligned with the goals of our organization as well.
AMA: How do you think improving your communication skills can help improve physician well-being and reduce burnout?
Dr. Awdish: Early in my career before I had these skills, I would avoid certain family meetings. Subconsciously, I would find a reason to add a patient on in clinic if I knew the “difficult family” was coming to the ICU. I was avoidant because of the toll those interactions took on me because I didn’t have the necessary skills to navigate the conflict that naturally arises in high-stakes family meetings.
The more I’ve worked to intentionally improve my communications skills, the more I’ve found resilience in myself. The deeper any of us develop our toolkits around emotional intelligence, attuning to the room and gaining situational awareness, the deeper we can go as healers.
That leads us to longevity in practice because no one can sustain the workload if they don’t have the tools to manage interactions that feel consistently depleting.
AMA: Your first book, In Shock, has become required reading in many medical schools. What do you hope future physicians take away from it?
Dr. Awdish: I hope they will find within themselves a willingness to go to hard places, which can look different depending on the situation. The common thread is being willing to look at what’s in front of you and not turning away. Sometimes that looks like using the word “dying” if someone's dying, which can be very uncomfortable for them.
Of course this doesn’t end in our medical training. As we move forward in our careers, the challenges look different. For physicians in leadership, it might mean knowing how to have a conversation with one of your colleagues who is struggling and saying, “I know you are a kind and compassionate person who wants to do the best for their patients, but I see you sometimes having a short fuse, and I’m worried about you.” Giving feedback at that level takes a different skillset.
Physicians and medical students will be able to learn more from my new book, After Shock: Learning to Reinhabit My Body After Illness, which will be released June 16, 2026.
AMA: How have you seen this type of communication become more common and prevalent since you started the program?
Dr. Awdish: Sustaining these workshops for 13 years has been challenging for a number of reasons. They are absolutely dependent on the commitment of our facilitators who are busy clinicians and educators with full-time jobs. They require leaders to carve out time away from clinical duties for us to spend time in community, working on our communication practice. The shared sense of purpose and feeling like we are effecting real change has definitely helped to keep it going.
Change is happening. The things I heard from my doctors when I was a patient so long ago, we wouldn’t say now. Our ears are attuned differently to what compassionate communication sounds like, and our ability to be present with suffering has changed.
Culture change is like steering a big ship. It can be imperceptible from day to day. Then, one day, you look around and you see a medical student holding a patient’s hand while we place a line. You realize that they recognize how a patient’s physical safety and comfort matters.
Years ago, physicians didn’t think about that. We just thought our job was to place the line. So, I have moments every day where I see change happening, and it makes me so proud.
