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Hospital Checkup

Acting the Part

They pretend to be ill--and get paid for it. Known as 'standardized patients,' they help budding doctors in a way that books and lectures can't.


Dianne Bye is not a patient, but she plays one at medical school.

Clad in an examination gown and calling herself Joan Brown, she tells a third-year medical student at UC Irvine she has suffered severe abdominal pain for three days, always after a meal.

She lies down on the table in what looks to be a doctor's examination room, pulls up her gown and allows her belly to be poked repeatedly.

"Ow!" she blurts out when the student tells her to inhale while he presses her abdomen. "It hurts more when I breathe in," she says--a telling response for someone with gall bladder problems.

In the exam room next door, another woman complains that she can't sleep.

Down the hall, a man is panicked about recurrent bouts of chest pain.

A young woman in another room seeks a new method of birth control.

But none of these people is really in need of medical attention.

No hypochondriacs, these recipients of sometimes unpleasant procedures and probing questions are being paid to act sick. They are known in medical schools as "standardized patients," living, breathing versions of real patient case files on whom future doctors practice and perform tests.

As if enrolled in "Bedside Manner 101," medical students practice how to express empathy, how to gain a patient's cooperation, how to win a patient's trust.

The students learn how to respect a person's modesty and comfort level while performing a physical exam. They practice how to ask the right questions to draw out a patient's complete medical history or to hone in on symptoms to make an accurate diagnosis. Other exercises might involve aiding a patient in stopping smoking or telling a patient he has cancer or AIDS and advising a course of treatment.

Standardized patients "are another type of teaching material. But these are live bodies instead of paper cases," said Elizabeth O'Gara, standardized patient coordinator for UCLA's School of Medicine.

"We are interested in more than what a student knows. We are interested in the application of that knowledge," said Dr. Alberto Manetta, senior associate dean of educational affairs at UC Irvine's medical school. "There are students who can recite all the different kinds of ovarian cancer. But that doesn't mean that, when they are presented with a patient, they can establish a path that leads to the right diagnosis."

All five of Southern California's medical schools employ these standardized patients, often drawing on the area's ample supply of actors to fill their simulated examination rooms. Most U.S. medical schools also use standardized patients.

Once scoffed at, they are so widely accepted now that by 2001, the national exam for licensing doctors is expected to test physician candidates, in part, with standardized patients instead of solely paper and pencil.

And perhaps the clearest sign that standardized patients have made it, they were lampooned on "Seinfeld," embodied by the character Kramer, who wins an acting job to portray a patient with gonorrhea.

Disappointed he does not get the plum role of a patient with cirrhosis of the liver, Kramer makes the most of his assignment by dramatically recalling an imagined romantic interlude that led to his disease, all to the applause of the medical students.

The episode was funny, but not at all like the scenes that took place recently at UC Irvine's medical school's Student Training Center, where eight rooms are furnished like doctors' examining rooms.

Jennifer Campbell is slumped in a chair in one room, a jangle of nerves with her knees bouncing nonstop and hands pushing back her unkempt hair. She just wanted medication to sleep, she told the medical student, as she tried to dodge questions about how much she drank and her troubled relationship with her live-in boyfriend.

After the exchange, a professor in the room advised the student to follow up the patient's answers more thoroughly. When insomnia has organic causes, it is only a symptom, he reminded the student. The standardized patient, as it turned out, needed treatment for alcoholism.

In another room, James Goss portrayed a bank vice president troubled by recurrent chest pains that mysteriously went away after a few minutes. Down the hall, a middle-aged woman posed as a seemingly healthy patient getting an annual physical exam, but she would not mention her menopausal problems unless the student asked.

Silently, video cameras perched high in the rooms captured the exchanges and piped in images to a screening area full of television monitors and VCRs, so that professors could view the tapes later. This battery of exams would make up 15% of the students' grade in their family medicine course.

"I'm having a great time doing this," said Doug Evans, a scuba instructor who was impersonating a patient with a skiing injury. "It gives you an insight into the learning process. You can pick out who will be the good doctors of the future."

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