Once upon a time, medical students learned from real people in actual hospitals, interviewing them about their all-too-genuine conditions. But thanks to the insurance-industry bean-counters, hospitals began discharging patients after shorter and shorter periods of time, and only the sickest hung around long enough for study. These patients could tolerate only so many repeated exams from a stream of medical students, and they began to suffer from the stress of having to answer the same tedious questions again and again.
The University of Minnesota’s solution was the standardized patient program. Basically, it’s a theater that employs a small cast of actors—professional hypochondriacs. Rookies need only to play themselves and act natural, as medical students look into their eyes and ears and down their throats, check their reflexes, and walk through other non-intrusive aspects of a standard exam. No blood is drawn. “Patients” are invited by doctors and recruited by on-campus fliers. “They don’t need to have any particular problem,” said Josh Chapman, who was a paid patient before he was hired to coordinate the program for the U’s medical school. “But it’s nice if they have an enlarged liver from a drinking problem or they had a stroke twenty years ago and their reflexes aren’t quite normal.”
Many standardized patients are people with disabilities who can’t work full-time jobs; others are retired. The average age is 50, but several U students work for the program, and one five-year-old employee gives medical students a chance for pediatric practice. Typically patients work for three hours a week. They’re often used in testing too, during which students go room to room and diagnose as many as 20 different patients with teachers grading them.
Once standardized patients have some experience playing themselves, they begin to take on more challenging roles, dramatizing different scenarios that aspiring physicians are likely to encounter, such as a confrontational patient or a patient who’s tested positive for a terminal disease. Scripts are used, and the actors practice with staff before meeting with the students. “Ideally the patients act the same way for every student so they can be graded fairly,” explained Chapman. His office can’t afford professional, dues-paying actors, but he said the people they have do a good job.
Evaluations suggest that the patients gain as much as the students do. “It’s almost therapeutic for some patients,” Chapman said. “They can talk to medical students and teach them how to interact with other people who have the same problem.” The continuing dialogue means that patients gain an understanding of doctors’ perspectives, and they feel less intimidated and more empowered to speak up and ask questions of their real doctors.
So how much does hypochondria pay? Employees of the program start at $10 an hour, and work their way up to $15 for the more challenging starring roles. It’s not exactly Screen Actors Guild scale—but probably better than a similar program over at the U’s school of veterinary medicine.—Katherine Glover
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