As I sit on the exam table in the sterile cocoon of my doctor’s office, clad only in a hospital gown and neutral beige undergarments, a lonely feeling comes over me.
Who am I today? Michele Jones? How long have I been married? When did my symptoms start? What am I supposed to say, when the young person in the white coat asks me what brings me here today? “This stomach pain just won’t go away.”
I rehearse my lines and pertinent medical history, waiting for the announcement that the medical students are on their way. I’m to appear worried, but not overly anxious.
Then there’s a knock on the door. It’s show time.
Being a standardized patient (SP), or a medical actor is strangest job I’ve ever had. I portray fictional patients in simulated patient visits with first, second, and third year medical students. All the “encounters”–as they are called–are filmed and recorded so faculty and students can review them to further learn what part of the exam went well, and what if anything, needs improvement.
If you’ve ever seen the episode of Seinfeld where Kramer gets ‘typecast’ for his bravado portrayal of a patient with gonorrhea, it’s riffing–humorously, but inaccurately–on the job of a standardized patient, One day, I could be an unemployed generation X-er suffering from anxiety. (Been there, done that); the next, I might be a menopausal woman hitting the ER with a compendium of symptoms designed to make even Dr. House blanche.
Sitting in the SP break room is like being backstage on a hospital TV sitcom. The ambiance is supportive and jovial, with many SPs coming from all different career paths. (Actors, retirees from education, hospitality, health careers). Unlike Cosmo Kramer’s scene-chewing, though, I don’t give emotional monologues and there is no dramatic stage lighting. SPs aren’t handed out diagnosis cards. We aren’t privy to what we have. Depending on the case(s) of the day, there will be ten to twenty of us, dressed in hospital gowns, slip socks, and bathrobes, drinking coffee, while we practice the day’s case, quizzing each other on the details of the patient’s history and chief complaint, in order not to miss anything the student asks.
I try to find something in common with every fictional patient I portray.
We all have tricks to remembering case details. I doodle body parts and symbols to remind myself of the location of pain or progression of symptoms. It also helps when an SP with theater background re-enacts vomiting, or shortness of breath, offering me free acting tips. I try to find something in common with every patient I portray. If the fictional patient is worried about a sudden frightening symptom, I’ll recall how scary it felt to wake up with chest pains 8 years ago, only to find out it was a case of pleurisy–an ailment I’d literally never heard of until then.
You might well wonder how I ended up pretending to be sick for a living.
Last January, I began a half-hearted search for an admin job at local colleges. The few job interviews I scored felt awkward, and by spring, rejection letters starteds dribbling in. I blamed it on my extended hiatus from the 9-to-5 life: a freelancer for years, the last full-time admin job I held was during the Clinton administration. Trying to distract myself from my disappointment over how the job search was going, I cracked open The Empathy Exams by Leslie Jamison, which explores her experience as an SP.
A lightning bolt struck me. I could do this! I’m comfortable in medical environments, enjoyed acting in high school and college. Before I even finished the author’s essay on being an SP, I had started searching for standardized patient jobs in my area, which landed me at Albany Medical College. After attending an informational meeting, a formal job interview, passing a mock trial, an employee physical, and the onerous application and background check, I’m back in the workforce, part time.
The specialized work of the standardized patient requires many of my unmarketable skills: offbeat humor, a capacity for deep unpleasant conversations, a curiosity in behind the scenes medical situations, and the ability to make stuff up on the fly. It is not for the super self-conscious. I memorize the case script, and listen quietly to students pore over symptoms and possible diagnoses. After my performance, I offer brief constructive feedback on the student’s communication skills using a checklist, while a seasoned 4th year medical student gives feedback on the choreography and organization of the exam, as well as more technical advice in non-translatable medical lingo.
Either way, I’m always rooting for the medical student no matter what snafu.
During these make-believe doctor visits, I have to multitask. In addition to performing a role, I take mental notes when a student misses an opportunity for empathy, or uses too much medical jargon, or asks a question in a judgmental manner. Many times the student’s natural compassion and confidence comes through, and I only have flattering feedback to offer. But sometimes, an unexpected symptom can stump a student into a brain freeze, and the flow of the patient rapport can be derailed. Either way, I’m always rooting for the student no matter what snafu.
The first time I participated in a physical exam practice, I was a little nervous. While all the other SPs were relaxed and chitchatting before First Year physical exam practice, I was as anxious as if I was going to a real visit to the doctor. What about my decrepit toenails? What if I sneeze or my stomach grumbles really loudly? I should have flossed today. Sporting my hospital gown and carrying a cup of water and my drape, I scurried to my assigned room. But as soon as I saw the student was way more nervous I was, I remembered that this is not about me: we are all just glorified bodies for the students to practice upon. My main mission here is to be my supple soothing self.
After five minutes, the student gets into the zone. One fellow SP told me that she silently screams positive affirmations in the hopes to calm the few very nervous students. I try it out. “Everything is going to be fine. You got this! You’ll be doing in your sleep in a few years!” It’s very rewarding for SPs who work at the same medical college for a graduation cycle, to see uncertain students grow confident and hone their patient rapport and history collection skills through encounters through their second and third years.
As part of my training, I had a physical exam by one of the faculty members, who went through the procedure that the students would be performing. I knew to expect the Babinski (scraping the sole of the foot in a certain obnoxious way to check for plantar reflex) or the dreaded thyroid test, which has been my biggest challenge: I’m ticklish, so it’s hard not to laugh as the student checks my thyroid by putting her hands around my neck. But I always try my best.
We standardized patients aren’t just actors. We’re educators.
When the case involves a physical exam, I have to remember more parts, because during feedback I may be asked how I felt during the physical exam, and I can bring up anything that I really appreciated (for example, asking me if I’m comfortable, and letting me know what they are checking for). If I felt uneasy when the student was pressing a little too much on my ears with the otoscope, I can gently bring it up in feedback, and then the 4th year who watched from the control room or sat quietly in the office, can show them a better way to perform the ear exam. (Resting a hand on the patient’s shoulder helps steady the student).
There’s something deeply satisfying about helping a student on their path towards being a doctor. Being a standardized patient, my body can work at improving the care of future patients, and help show doctors-in-training the ropes. Which is ultimately what, I think, I find so deeply satisfying about the job, six months in. We standardized patients aren’t just actors. We’re educators. And in a roundabout way, I’m using my body to help other people save lives.