How much do we think about our myriad daily interactions?

Every time we connect with someone – with a glance or a smile, however fleeting – and with every word we speak, we share more than information or knowledge: we share a personal message about who we are. And every day is different; we open up some days like a clam exploring the ocean’s edge, while other days we embrace the day with open arms – fearless and irrepressible. The more we’re in touch with the waves of internal feelings that move and shake us, the more likely we are to be successful communicators.

This awareness is especially important for those, like me, in a professional role as a physician-lecturer, but as adults we all participate in various important and influential roles, including mentor, teacher, parent, partner, friend, or leader – and in each of these we support and facilitate the learning, progress, and health of others.

When we fail to communicate effectively, we underachieve in all of the above roles.

Oftentimes, learning to connect requires that we step out of our comfort zone – stretch, in fact, to accommodate the needs of another. This “other” can be a fellow human being but it can also be an animal. A great example of an unusual human-nonhuman connection is revealed in a recent documentary film, “My Octopus Teacher”, and the lessons learned within the weeds and murky depths of the sea.

My story, about what happens when we step out of our comfort zone, begins many years ago at the age of four when my older cousin took me out riding on an old, reliable farm horse by the name of Smokey. Later, when I was seven, I spent a much-anticipated stay at my same cousin’s farm, in the interior of British Columbia. It was 1966 and my aunt had me doing chores like skimming the cream from their cow’s daily milk, slowly churning it into butter. I delighted in visiting the rabbit’s hutch – careful not to touch or handle the furry balls – the kits – to avoid confusing the mother rabbit with my scent. I gathered eggs from the chicken coop, dancing around their nervous pecks and claws.

My favourite hangout by far was the barn, with the horses. I loved spending hours rubbing their bellies and reaching up as high as I could reach, to pet their necks and hope for a nuzzle from their wet, nibbly noses. Years passed, and in my early teens, I took English equestrian lessons – and formally learned the basic skills of riding and jumping. Over the years, as we moved from one home to another, across Canada and then to Germany and back, I begged for my own horse. For many practical reasons, that dream never materialized, but I found gratifying opportunities to ride with friends who had horses – the next best option to having your own! In memory of my brother Greg, who died from brain cancer in 2012, I spent a year learning simple dressage (what I call the “ballet” of horseback riding) and fell in love with horses in a new way – using my legs, body, and even thoughts, to communicate with them from the saddle.

Photo by Pieter van Noorden on Unsplash

What is it about time spent on or around horses that can be so rewarding?

Perhaps it has something to do with how horses reflect back what they see in us. Like a “mirror, mirror on the wall”, they are forthrightly honest about how we portray ourselves to the world. It definitely has something to do with which insights we gain each time we enter the stall or corral with a horse.

You’ve likely heard about horse whisperers – seemingly gifted people who can settle, charm, and train a horse of any size or temperament. In their stories, they describe the often “tough and tumble” lessons learned at the feet of horses.

One of the world’s well-known horse whisperers is Monty Richards. In his book, The Man Who Listens to Horses”, he describes their world:  

“The flight animal (horse) wants only to reproduce and survive; fear is the tool that allows that. Humans, on the other hand, are predators (fighting animals). Our preoccupation is with the chase and having dominion over other creatures in order to eat them or use them for our own ends. In order to gain a horse’s trust and cooperation, the human must never abuse his status.”

In Geraldine Brooks’ book, Horse, her main character (Jarret) is described as follows:

“His first language had been the subtle gestures and sounds of horses. He’d been slow to master human speech, but he could interpret the horses: their moods, their alliances, their simple wants, their many fears. He came to believe that horses lived with a world of fear, and when you grasped that, you had a clear idea how to be with them.”

In the recent past, as I began to think more about how to apply “horse smarts” and their innate prey psychology to my own life, I was drawn to yet another book, authored by the incredibly multi-talented Allan J. Hamilton: Zen Mind, Zen Horse. Hamilton is an accomplished horseman in addition to being an internationally renowned neurosurgeon and manages to fuse his passion and love for both into an extraordinary relationship with patients and horses alike. He states:

“Our salvation is going to be to go back to what really makes us fulfilled, which is this essence of human-human interaction and the ability to take somebody in the direst of circumstances and say, ‘grab my hand, I know we’re going to be OK; we’re in this together.’”

Fortunately for me, a few years ago, I became good friends with a local horsewoman, Nikki Kagan, who excels at teaching leadership and communication skills via human-equine interactions. In her book Instinctive Leadership, Nikki writes:

“Horses are the epitome of presence – living in the present. They see through to our core and respond accordingly – often before we are ready to admit to ourselves our own feelings and fears.”

After a long conversation with Nikki one day, over lunch at her home – nestled on a quiet moshav (farming community) in central Israel, replete with her cadre of four special horses – we stumbled onto the idea of using her skills with horses and leadership to help me teach my first-year medical students about compassionate and effective patient communication.

It turns out we weren’t the first ones in the world to think of the idea!

I discovered that my role model and horseman-physician, Dr. Hamilton, had already teamed up with Dr. Beverly Kane to develop a program at Stanford University in 2005 to do just that and now the curriculum is used more widely, including at UCSF and the University of Arizona. The organizers of the program wrote:

“The skills learned working with horses help participants build confidence, mindfulness, and emotional intelligence. Encouraging the cooperation of the horses by the students required a number of factors, including rapport, trust, clear communication, patience, tone, body position, eye contact, respecting boundaries, and acceptable touch. It is clear that these are the very same factors that enable patient compliance, cooperation, and improved outcomes.”

Likewise, similar academic curricula were being developed elsewhere in the USA. Published in the magazine “Equus” in November of 2022, Kevin Liu, MD and Connie Crawford from Brown University – an avid equestrian who teaches students – make the statement that:

“We believe that horses offer an excellent analogy for human patients. The horse models a patient who does not speak our language, is from a different culture and is in a stressful situation. When a medical student unfamiliar with horses interacts in a foreign setting with foreign beings, their own self-preservation heightens. Two beings with strong self-preservation offer wonderful complications of communication. Working with students to be mindful and compassionately aware while dealing with new situations that could be dangerous develops their confidence.”

Based on these encouraging experiences and accounts, Nikki, my teaching colleagues Drs Evie Kemp and Sharon Akrish, and I organized a 1-day student activity with the horses. It turned out to be magnificent – a day of exploration and of forging new bonds (both between students and teachers and students and horse!). We closely followed our main objectives, aimed at developing attentive listening, compassion, and confidence. How that translated to student-horse activities in the ring was a challenge that Nikki handled with ease.

Student Israel Weiss with horse Yan

For example, one exercise had the students walking and being with the horse, paying attention to the animal’s pace, position, and body posture. By observing the horse’s gait, they had to suggest what its personality might be like. They were asked to consider how their own body language informs others of their personality, mood, or vulnerabilities.

Itay Moalem, one of the participating first year students, summarized his experience as follows:

“Horsesense taught me that communication without words can be impactful. I learned that both patience and compassion can go a long way (in forging a relationship) and that they can be expressed in many forms. This is important both for our day-to-day lives as physicians and in our communication with patients as well as colleagues.”

Itay, in a quiet moment with Yan

Understanding prey animals, like the sensitive and intuitive equus, and appreciating the long history during which mankind has tamed horses for his personal use, has revealed there is much to be gained by exploring equine-assisted teaching of compassionate communication. Medical school programs are extensively advocating these skills and, now in the post-corona era, physician support programs and associations are emphasizing self-care to prevent physician burnout and compassion as part of quality patient care. Our experience was an invaluable catalyst for more diverse, creative, and in-depth learning opportunities for effective communication in our medical curriculum.

(Special thanks to the student participants of the Technion American Medical School in Haifa, Israel and to Drs Sharon Akrish, Evie Kemp, and of course Nikki Kagan and her gaggle of lovely, accommodating horses)