"Fake patients are just what the doctor ordered"

A classmate sent around this Denver Post article about standardized patients, and I want to share it here to give my readers a better idea of what standardized patients are all about:

By Jennifer Brown
Posted: 11/24/2009 01:00:00 AM MST

More than one nervous medical student has entered Robin Mulroney's hospital gown from the bottom to listen to her lungs.

Aspiring doctors also have been known to forget to release blood-pressure cuffs after taking the vitals of their "patient." And there was the time a student inserted a speculum upside-down during one of LoriLynne Lawson's many pelvic exams endured in the name of training future physicians.

The days when medical students learned how to examine patients just by watching real doctors in action and then trying it themselves are now supplemented by people such as Mulroney and Lawson: "standardized patients" who are paid $20 to $50 per hour to let students poke inside their ears and tap on their stomachs.

These fake patients, many of them professional actors looking for extra money, can cry on demand when they are "diagnosed" with cancer or Alzheimer's disease. Strong memorization skills are a must: Patients have to stick to a script saturated with family history of disease, medications, sexual history and surgeries.

Standardized patients are in higher demand than ever in Colorado with the opening of a second medical school in the state last year, Rocky Vista University in Parker. Rocky Vista, an osteopathic school, and the University of Colorado Denver School of Medicine each employs about 60 actor-patients, some of whom work for both schools.

The universities also have high-fidelity simulators — manikins ranging from $20,000 to $250,000 that take over where actors cannot: Give birth, have heart murmurs, bleed out, receive drug injections and require intubation.

Many actor-patients say they don't do it for the money but to help future doctors develop empathy, better listening skills and a gentler touch. After their exam, patients evaluate students as part of their grade.

"I want them all to succeed," said Rich Beall, who also has worked for the Denver Center for the Performing Arts and had a TV role on "Perry Mason." He doesn't hold back when it comes to constructive criticism.

"If someone comes in with a lab coat that's not clean, you note it," he said. "I had one gal come in all dressed for a Saturday night."

"Patient" doing her part

Mulroney, who has worked as a standardized patient for nine years and now trains others, believes she's doing her part to prevent that rare "doctor from hell" encounter. She recalled a real-life experience in which a specialist walked into the hospital room of one of her relatives, flopped into a lounge chair and without even introducing himself announced, "So you have lupus." The doctor kept talking "90 miles an hour" even after the woman burst into tears.

"His empathy, his patient care for the whole patient, the emotions of the patient, it was just tragic," Mulroney said.

Last week at Rocky Vista, 10 first-year medical students wearing white lab coats and clutching medical bags lined up outside their assigned exam rooms. One was so nervous beforehand that she put her fingers in a yoga pose and sighed, "Zen." With the sound of an alarm, each student knocked on an exam-room door and stepped inside to greet an actor-patient sitting on an table.

The students had 50 minutes to perform a routine physical examination, observed by faculty and recorded in a control room down the hall.

Meredith Kirtland, 26, sailed through the "patient encounter" after she had practiced on her fiance and some friends. "Just a couple questions about your sexual history," she told her male patient at one point. "Sorry, it's a little uncomfortable topic."

Her professor's one small critique: She should have lowered her patient's pants farther to feel his lower abdomen.

Kirtland was too busy running through a mental checklist to think about the fact that the patient was an actor. It was a lot easier to examine him than her friends, who are "kind of giggly and you know it's not real," she said. "Everything else in that room is so real. What better way to learn it?"

The highest-paid patients are gynecological and urological teaching associates who guide students through pelvic exams. Lawson, a 53-year-old with scars from a C-section and a breast lumpectomy, has had up to 14 gynecological exams in one day.

She had one student remove the speculum without closing it. And she chuckles remembering some of the clumsy statements students have made, as in, "Let's just take a feel now, shall we?"

Lawson doesn't tell everyone she knows about her job. "Some people say, 'Ewww, how do you do that?' Some people think you are prostituting yourself," she said.

But Lawson remembers holding her daughter's hand during her first pelvic exam. "I was glad they knew what they were doing and hadn't just practiced on a plastic doll," she said.

"Making a difference"

Gynecological teaching associates typically are feminists "who know their bodies like no other" and have a "real strong belief that they are making a difference in the world," said Gwyn Barley, director of UCD's Center for Advancing Professional Excellence, which employs the actor-patients. Men submit to urological exams, she said, because there are "so few opportunities of any sort for students to learn the male genital exam."

"There is so much kind of mystery," she said. "You can't just ignore the male reproductive system."

Chelsea Williamson, 25, became a standardized patient after she was laid off as a cabinet designer last spring. She has found that some medical students need to work on their listening and sensitivity.

While she was portraying a girl with severe psychological problems who cuts herself, one student kept saying, "Gotcha." Another said "Great!" after she informed him that her parents were dead.