Standardized patients (SP) are people recruited by the medical program to act as our patients to practice on. The tasks range from taking a history (they are given a binder script), to completing physical examinations. I remember reading an article or two about the possible ethical dilemmas associated with this job. There was also this one story about how an abdominal aortic aneurysm was discovered and the SP’s life was saved. Sometimes they have findings, sometimes they don’t. I don’t know much about the paperwork they have to do, or the training they receive with regards to us making accidental discoveries (which I do hope is present). But I’ve had many encounters with SPs that I’d like to share.
In my undergrad, I took a communications course which allowed us to work on our interviewing skills with standardized patients. The acting was impeccable. During the interviews, I forgot that these were actors for the 12 minutes, and felt like I was submersed in a whole new world. Seeing these actors around later was very strange. It was hard to dissociate them from the context in which I knew them… the girl with diabetes, the abused housewife, the suicidal boy… And I would wonder if any of their stories reflected their own lives. It’s almost like forgetting that your favourite actors on the movie screens are simply actors. Like teenage girls who associate the on-screen romantic heartthrob with the person’s personality.
Seeing the same SPs as a medical student helped. When they are recruited for physical examinations, they become less of a character, and more of a person to practice on. (Unless you count examination situations, then I don’t even have time to process my own feelings towards them in the midst of being incredibly nervous.) For tests they will have make up on or some “findings” put on by the school, but in the practice setting, they are who they are. It is like practicing on my classmates, except they are paid by the school. Sometimes it is just that simple. Sometimes thoughts creep into my mind, and I start to wonder about their own stories.
Depending on the group, we sometimes pair up and practice on each other, and the odd person or group can also practice with the SP.
One time, I was practicing the musculoskeletal exam on an SP. It was of the upper limb and back, and they were wearing a T-shirt. I went through the examination, then I noticed wisps of scars laid across her forearms. They were faint, but they were present. I would be able to recognize that anywhere. I had a couple of friends who practiced self harm in high school, and over the summer, I had an elective in Psychiatry where I had seen this practice in the extremes. I had flashbacks of the girl lying on the bed in the hospital, her arms filled with so many scars you could hardly find a spot that wasn’t scarred. At first, I thought they were blonde strands of hair on her arm. I don’t think I will ever forget that image. This SP, her scars were faint, from years passed. I don’t know if she knew I noticed them. I didn’t ask her about them. I think I may have asked if everything was okay if the scars were fresh. But they were so faint… What if they were just an impulsive decision that she wanted to forget? I didn’t have any actual conversation with her, and in the busy clinical exam room with pairs of students practicing was not the best place to ask. That night I went home, and I slightly regretted my choice to leave it alone. Would it have been intrusive or relieving for her? Sometimes I wonder how she is doing now. I haven’t seen her again since then.
Another time I was practicing my fundoscopy exam on an SP. I am not very well versed in the exam, as are most medical students, and it took me many tries until I was able to find the optic nerve. When I pulled away, he asked me if something was wrong, and I explained to him that it was quite difficult. He apologized and explained that he had been crying today, and wondered if that could affect it. I quickly reassured him that it wasn’t him, it was me. Then I asked if everything was okay. He told me there was a death, and he was quite upset with that, among other things. I told him we could stop if he wanted to go home, that I could practice on someone else. He told me he was okay to proceed, and I asked him if he was feeling okay. He smiled and responded that he is doing fine. Then we continued the exam. I think after that point I made a conscious effect to be more vocal and dynamic. I told more jokes, I tried to make him laugh (and he did). Sometimes I wonder how he is doing now. I haven’t seen him again since then.
Sometimes thoughts creep into my mind, and I wonder how the next chapters of their stories are going.