March 25, 2011

Standardized Patient


            Under the white hospital gown, I am wearing underwear and I'm waiting for the Doctor. The room is bare; next to the ceiling a small digital video camera is trained down to film my next interaction.  
            Despite what it looks like, I'm not a patient and I'm not really visiting a doctor. No: I'm a standardized patient at the university medical school, and am administering a test to medical students. Today, I'm a patient with a "Duodenal ulcer" and I'm in a lot of pain.
            As third-year students, they are to interview me, obtain a relevant medical history, perform a simple diagnostic examination, make an initial diagnosis, explain a treatment plan, and do it all within 15 minutes while I grudgingly answer and make sure they understand how much pain I'm in.
            As a standardized patient, I am one of four actors playing this case. It's a strange job, and one I had no idea my limited training as a Dungeon Master and performance poet would uniquely qualify me for. I've never acted. My one try-out for the high school musical happened when I was having an allergic reaction and my voice sounded like I'd swallowed rocks. So, to think that I'd be able to put "actor" on my resume at some point, still surprises me.
            This case is one of my favorites. Most of the time, we've covered all the bases in training and some of the questions they ask, "Does it hurt when I do this?" or "When did this happen?" are merely routine. Occasionally, however, they ask questions we haven't anticipated, and then I'm  to respond the best I can not straying too far from the character but also not giving up any relevant information they should be finding on their own.
            They know I'm a standardized patient, know that they are being tested on certain things, and know that I have the test, essentially, memorized. But, I'm also acting a part and thus just answering as this patient naturally would, "No. I don't have a drinking problem. I drink a couple of beers after work every day, and more on the weekend, but that doesn't have anything to do with my pain. And yes, I smoke, but only when I drink. And can we speed this up? Can you give me something for this pain?"
  

          Today, for some reason this group of students keeps surprising me. Without fail, they seem to all think I have Pancreatitis or maybe my appendix has ruptured. And as they explain what my treatment options are, I keep having to suppress my laughter as they tell me they'll have to give me a rectal exam. Now, rectal exams aren't funny, but having to listen to a medical student, maybe in her twenties, explain the actual procedure of giving a rectal exam is. Likewise, I'm no more willing to get a rectal exam, but have to stay in character and suppress my own laughter as she squirms around the subject. Neither of us is comfortable with this topic, but this could be a relevant treatment and while she's "pretending" to be the doctor, and I'm "pretending" to be the patient this may indeed be information or a series of questions she's being tested on. It's not, but what am I supposed to do? Part of me wants to flip over on the table and say, "I'm ready. Go ahead. Give it to me." The other, more mature part of my personality, though, takes over, "Okay, but can I get something for  the pain first?"
            This is an important job. While I am merely pretending to be a set of symptoms and a memorized history, the practical, face-to-face interaction with the students is invaluable. In the real world, there can't be any pretending and while I may not have to be completely comfortable with the details of this case, the students may indeed have to do this very thing. Their patient's health and well-being isn't a laughing matter, and anything that may help them exude confidence, comfort, knowledge, and competence will help them be better doctors. In the real world, I don't want "doctor" to be merely a role that she's acting.


December 2004

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