An actor a day shows young doctors kind ways

June 08, 1993|By Caryn Eve Murray | Caryn Eve Murray,Newsday

NEW YORK — New York

The patient was restless and inconsolable, her body wrenched alternately by grief and fury from the diagnosis the doctor just delivered: cancer of the pancreas. Most likely terminal.

"We can relieve your jaundice and your pain," the young doctor, Elie Abadie, quietly assured the trembling woman. "We can make her comfortable, treat the pain very well," he softly told her husband, who slid slowly toward his own emotional explosion.

"You are saying," the husband blurted suddenly and violently, lurching toward Dr. Abadie, "there is nothing you can do?" Dr. Abadie sat immobile, his brow creased from his hard search for words of gentle reassurance. "We can," he said finally, "make her comfortable."

But relief eluded Dr. Abadie as well -- coming only after Dr. Edgar Lichstein, chairman of the Department of Medicine at Brooklyn's Maimonides Medical Center, stepped in. The couple -- actors Mary Kilpatrick and David Kramer -- were simply doing their jobs as "standardized patients," challenging Dr. Abadie at medicine's most personal level.

"It is reassuring to know this was only staged and that, at any moment, it is going to stop," the 31-year-old resident said, his palms still sweaty. "That you will wake up from the bad dream."

It is, in fact, the reality behind these re-created scenes that educators at Maimonides and increasing numbers of other hospitals seek to capture by using this experimental method. The technique, used both for training and evaluating physicians, takes many forms in many forums, from hospitals to medical schools.

Alternately known as programmed patients or simulated patients, standardized patients and their use as a human barometer in the education and evaluation of doctors is finding its way into mainstream medical routine. It aims to measure what some critics claim is immeasurable -- and to cultivate it.

Proponents point to studies claiming that improved doctor-patient communication creates a greater likelihood patients will obey orders and lowers the chance they will sue for malpractice. Some even say the introduction of standardized-patient training also signals medicine's desired return to the old-fashioned, hand-holding doctor who heard every symptom, chapter and verse.

"Basically, this is a live body -- as opposed to a paper-and-pencil exercise or computer simulation -- who is trained to replicate a clinical encounter in a realistic and consistent fashion," said Dr. Paula Stillman, curriculum dean at the University of Massachusetts Medical School in Worcester and a nationally acknowledged pioneer in standardized patients. "The body can serve as a simulator, an evaluator or as a teacher," she said, with the ideal being a combination of the three.

Developing bedside manner

In short, the technique develops the bedside manner, even with the bed absent. And it comes at a time when medicine is awash in two opposing currents -- mechanized depersonalization, represented by growing reliance on high-tech diagnostic devices; and the human factor, a combination of increased consumer activism, malpractice suits and doctors' growing abilities to directly discuss difficult areas.

Use of standardized patients reflects much more than new openness, said Dr. Stillman. "I think maybe it's a recognition that basic clinical skills are important, and that these skills, and communication, which were considered not really teachable, can taught."

But according to the American Medical Association, no more than 30 of the nation's 126 accredited medical schools use standardized patients, either routinely or even as a one-time sociological experiment.

"Standardized patients can be used throughout the entire spectrum of clinical skills," Dr. Skillman said. "To teach physical exam skills, to teach interviewing skills for data collection on patient history, and to teach patient education counseling skills."

An 'untraditional island'

At about the same time Maimonides introduced standardized patients, Winthrop University Hospital in Mineola, N.Y., began employing simulated patients in physician-interview sensitivity training for medical students from the State University of New York at Stony Brook.

Dr. Marius E. Chagoury, Winthrop's coordinator of Family Practice Education and a Stony Brook faculty member, calls the program "an untraditional little island in a sea of traditional medicine."

At Winthrop, standardized patients function as teachers -- gentle, nurturing coaches who began working several months ago in a one-day workshop format with second-year medical students.

"I think everyone except pathologists had better be good at communication with patients," said Dr. Nancy Levine, co-director the University's Introduction to Clinical Medicine course, which holds the Winthrop workshops.

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