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Playing patient, not doctor

(09/29/06 9:00am)

April Jones is not in a good mood. She has come in to see her doctor for a routine visit, but her work as an auditor for the Internal Revenue Service has been causing her a lot of stress, which would explain her annoyed, angry demeanor. But April Jones is not a real person - she's a character being portrayed by a local actress. And the doctor interviewing her is actually second-year Medical School student Sarah Chu. The mock doctor's office visit is part of the Medical School's Standardized Patient Program, which employs about 100 professional actors and laypeople who pose as patients for medical students. The "standardized patients" call themselves SPs for short. "They don't have to worry about prescribing the wrong medication. … It's just a safe environment for them to practice before they start going out into the real world and practicing on real patients," said Denise LaMarra, the program's director. In the fall and spring, standardized patients work almost every day and are used in a variety of courses, LaMarra said. This week, students in "Introduction to Clinical Medicine" had opportunities to practice taking their mock patients' medical histories. "For this particular program, we have a variety of challenges - patients who are defensive, overly worried, distracting," LaMarra said. "In another program, we use SPs to demonstrate a flirtatious patient … [or] a patient to whom students have to break bad news. "The possibilities are endless." As the Med students gain more experience, they will begin practicing complete physical exams, LaMarra said. Some of the situations can be difficult. Since the program's coordinators see it as vital that students learn how to work on the opposite sex, male students, for example, learn how to do a breast exam on female SPs. "The SP will tell the male student the right way to push her breast," when checking her heartbeat, LaMarra said. Instructors and students alike see the program as a valuable tool. "The program has allowed us to have the students get very intense feedback on their interpersonal skills, which gets them before they ever build up bad habits," said Janet Hines, who teaches "Introduction to Clinical Medicine." To ensure the integrity of the program, SPs do not break character during training sessions, even when they're not directly interacting with medical students. They frequently change the personas they portray so that medical students do not see the same patient twice. "We don't want to remind students that it's fake, so we want to keep it as real as possible for them," LaMarra said. The actors are trained to provide constructive feedback and guide the students through certain procedures. During a practice examination this week, for example, Chu asked her mock patient Jones if she had ever been pregnant. Jones - out of character, after the checkup - criticized Chu for showing discomfort when the patient implied she had had an abortion. And the SPs appreciate the work, which is consistent and pays $20 per hour. The program hires actors of all races and from age 18 to the elderly. Some have graduate degrees in acting technique; others are housewives and bartenders out to make some extra cash. Trevor Warner - as his character was named earlier this week - says he first began working as an SP because of the opportunity it gave him to practice his improvisational skills. The actors cannot disclose their real names because administrators do not want medical students to discover their true identities. Warner has acted in Philadelphia for 11 years and has degrees from Temple University and the British American Drama Academy. This week, he is acting in Angel: A Nightmare in Two Acts, so when he leaves work as an SP, he only has two hours before he has to be at the Walnut Street Theater. The Medical School's SP program was first introduced in 1997, but SPs have been used in medical education for more than 20 years, according to information provided by LaMarra. "We are responding to the way things affect us viscerally as people, but within the boundaries of the character that we are given," Warner said.

https://www.thedp.com/article/2006/09/playing_patient_not_doctor

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