The white-haired woman speaks in a soft, whispery voice as she sits on the doctor's exam table like a prim schoolgirl. Dressed in a blue hospital gown, her dangling feet in mismatched socks, she is shy, a bit tentative as she answers the questions of the young doctor-to-be examining her at Mount Sinai Medical Center in New York.
But the minute the doctor completes the exam and leaves the room, the woman bolts from the table, swings a chair up to a nearby computer and begins typing like mad.
A New York actress, Jo Ann Wahl is paid to play a "patient" with a specific complaint, undergo a physical exam and then score the young doctors conducting it. Were they respectful? Did they listen carefully? Did they encourage questions?
"I've been doing this for five years, and I've learned a lot about what a good doctor should and should not do," says Wahl, who has performed on stage and TV, including on One Life to Live.
The medical students and residents know they're examining actors, that the exam is being videotaped and that they will be graded.
"Doctors may be book-smart, but we want them to use their emotional intelligence, too," says Terry Sommer, director of the Morchand Center for Clinical Competence, which oversees Mount Sinai's program. "We want them to take in the whole person...not just see a walking set of symptoms."
Two-thirds of the country's medical schools now use actors to help young doctors perfect their bedside manner—stressing respect and empathy for the patient as well as medical knowledge—in response to patient complaints that doctors are too detached and distant. Creating a rapport with patients—asking them carefully and compassionately about their symptoms and their medical history—is more than just courteous behavior, the experts say. It's good medicine.
"About 75 to 85 percent of all patients in a general practice can be properly diagnosed—without tests—if the doctor asks the right questions," says Erica Friedman, M.D., medical director of the Mount Sinai program. The Morchand Center, on the 13th floor, recruits and trains the actors, and has seven exam rooms with hidden cameras for videotaping medical students from Columbia, Yeshiva University's Albert Einstein College of Medicine, New York University and the State University of New York at Stony Brook, as well as Mount Sinai.
Medical schools began the movement to humanize doctors about 10 years ago, and it has been gathering speed ever since. In 2004 the National Board of Medical Examiners started testing all U.S. graduates in clinical skills, assessing how they perform a physical exam, take a patient history and talk to the patient. Unless the graduates can pass this exam—along with tests on basic science and clinical knowledge—they will not be licensed to practice medicine.
"I think we're sending a message that these are critical skills," says Ann King, an assessment scientist with the National Board of Medical Examiners in Philadelphia. "We're saying that what doctors do when they actually see a patient is just as important as the other components we assess."
Good personal skills, experts say, not only mean better medical care but higher patient satisfaction.
A study reported last spring in the journal Mayo Clinic Proceedings found that when patients were asked to describe their best and worst experiences with doctors, technical expertise was rarely mentioned. Instead, the best doctors were described as honest, compassionate, respectful and thorough; the worst were arrogant, callous and dismissive.
"When I was in med school, we practiced on each other and then we jumped right to working on patients in the hospital," says Mary Jo DiMilia, M.D., assistant professor of medicine at Mount Sinai. "This program would have helped us for sure. It gives doctors a chance to learn how to deal with people, their problems, before they encounter real patients."
"Standardized patient" training uses actors who have been given a detailed personal and medical history of their character. So each med student who examines that patient encounters the same personality, symptoms and answers to questions. The actors also are given checklists or guidelines to score the doctors.
Wahl generally gives the young doctors she works with at Mount Sinai high marks. "But the one today—she was abrupt, abrasive," the actress says. "My character, who is 73, was there for a checkup. But this doctor walked in, saw the age on the chart ... and out of the blue started asking about memory problems.
"Just because someone is older," Wahl says, "doesn't mean they have memory problems. It was rude, disrespectful." And the doctor's test score suffered because of it.
Down the hall from Wahl, actor Bill Tatum, an alumnus of As the World Turns, summer stock and TV commercials, was in another exam room, playing a 51-year-old man who complained of debilitating fatigue. Although the man had "symptoms" of a common disease, some students incorrectly diagnosed the problem, suggesting everything from colon cancer to anemia. "Some of them just didn't ask all the questions they should," Tatum says.
In the tiny Mount Sinai "greenroom"—where the actors gather before and after their performances —an entire wall is covered with glossy publicity photos of the professionals who have worked there.
The program is so well known that actors now audition to work there between other acting jobs. An episode of the popular TV comedy Seinfeld even featured Jerry's quirky neighbor Kramer being hired to play a patient in the Mount Sinai program.
Schools in smaller towns, far from Broadway or Hollywood, have their talent pools, too. "We hire people from amateur theater groups in town and from the university's theater department," says Judy Bell, director of the assessment center at Creighton University School of Medicine in Omaha, Neb. Med student Briana Amosson, 25, says Creighton's program "teaches you to really see the patient as a person."
Whether professional or amateur actors are used, students tend to give the training high marks even if what they—or their professors—see on the videotaped exam makes them cringe.
At Mount Sinai, former Morchand Center director Devra Cohen recalls tapes that showed young doctors and students sitting "silently with their arms crossed while the patient cried. We would point out how much better it would be if they just leaned over and offered a box of tissues, or a reassuring touch."
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