I doubt my grandmother would consider this …

I found a wonderful gem of a story today. One that I think will be the basis of a MetaFilter post. It arrived in my inbox courtesy of Medscape. Now, I don’t mind Medscape/WebMD. It’s a fairly good aggregator for medical news, and they do have quite a bit of CME activity. They do tend to fill my e-mail box with lots of fluff, but it’s just electrons after all.

So, as I was sorting through some e-mails I figured I’d have a look at their “MedPulse Weekend Edition”. The topic was geriatrics, which is the diametric opposite of where my interests lie. There was, however, one headline that caught my eye: “My Mother, A Professional Patient”.

Now, my first thought was that this was a story about a woman with Munchausen’s or some type of personality disorder. But lo and behold it was written by an internist whose mother had developed an affinity for medical subspecialists:

“The truth is that my mother does have an assortment of medical problems, some serious, some not. Yet the real reason for her frustration was that no physician was able to make her feel the way she felt, say, ten, twenty, or even fifty years ago. I was frustrated, too, and was becoming increasingly uncomfortable at using whatever academic title I held at the time to gain her access to busy practicing physicians …

… I’ve spent most of my career in academic medicine, immersed in medical education at one level or another, but even so it took some time for me to come up with a solution that—almost overnight—made both my mother and me less frustrated and perhaps even a bit more comfortable with her life and medical situation. I called someone I knew at a medical school in Philadelphia and asked if the school had a certain program. “Certainly,” was the reply. Then I asked how my mother could interview for it.”

His solution? Sign his mother up to become a standardized patient. Now, when I was in medical school, our program had just started using standardized patients to teach and test our clinical skills, but these programs have been along for quite some time (at least twenty years, probably longer). These individuals are often lay persons, trained to act as patients. They’re taught the signs and symptoms of diseases, what medical students are required to ask and examine, and what constitutes a competent medical examination. We also had standardized patients to practice our physical examination skills on. For the most part, these were people who were compensated to allow us to listen to their heart and lungs, palpate their abdomens, and practice musculoskeletal and neurologic examinations. They reinforced what was correct and incorrect about our technique (with the assistance of the course instructor). While these types of tests seemed a little hokey at first, once you started you got sucked in and really believed that standardized patient was a real patient. And, from my experience, these standardized patients took their jobs and responsibilities very seriously. They became very good at picking up on subtle aspects of the exam where people excelled (making good eye contact) and where people may have fallen short (having the patient go from sitting to supine to sitting too many times).

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As an aside, we also had standardized patients to practice breast, pelvic, genitourinary and prostate exams. This was truly a unique group of people. I can’t think of too many persons who would list as part of their job “repeated digital rectal examination by nervous second-year medical students” or “ability to demonstrate the proper use of a speculum and location of the cervix on myself”. But, thankfully, there are, otherwise I’d feel particularly bad for all of the patients on the receiving end of that third-year medical student’s nervous attempts. I recently found a terrific piece in the Village voice by Jules Lipoff, who was a 2nd year medical student in 2005, entitled, “Dr. Strangeglove (or, How I Learned to Stop Worrying and Do Breast and Pelvic Exams)” that describes the experience of learning from these “patients”.

In any case, back to where I started, Dr. Wartman, the internist with doctor-loving mother, writes about how not only did his mother take to the program like a fish to water, but that she too takes seriously the role she plays in the education of medical students:

“She told me that she’d learned so many things that she had never known about, such as how a doctor should come in to see a patient, wash his or her hands, and use the patient’s name frequently. She is amazed at the amount of material medical students need to learn and how much “help” they need in applying what they’ve been taught. She loves the part where she gets to talk to the students after the session to give them her feedback. Although she tells the students where, in her opinion, they need to improve, she tells me that she is also mindful to give them positive feedback as well. She notices how nervous they are, and she often tells them to smile and lighten up. She’s proud of learning to use the computer and how to evaluate students properly. She’s become comfortable in front of a camera (it’s even something that she now enjoys). And, she told me, “The pay is good.” “

The full text of the article can be found here (may require either registration on Medscape, or the use of BugMeNot). If you prefer, you can download a .pdf version here.

Addendum – Some new things to add to this post include:

  • The aforementioned MetaFilter post (always good comments when you post something to MeFi).
  • A similar post on Kevin, MD discussing the pay for standardized patients.
  • A long newspaper article on the use of these patients at Stanford.
  • Another article in the Sacramento Bee (for username and password, click here).