Standardized patients

On Saturday I had the big daddy of pre-clinical medical school experiences: I performed rectal, genital, and breast exams on a man and a woman paid to be our living, breathing models. We have been prepped over the past two months, first starting with assigned readings and lectures, then watching videos, then practicing on little plastic models made of materials that try, but fail, to mimic what humans feel like.

My classmates think I am a little odd, but this workshop is something I have been looking forward to for a long time. Coming into medical school I wanted to be a gynecologist, though I may have changed my mind, and even worked in a women's health clinic for a few years. I finally got to perform the exams myself after assisting with hundreds of them! The feeling is akin to getting behind the wheel of a car for the first time after being a passenger for a lifetime.

On Saturday I had talking, feeling, warm people expose their most private body parts to me for the sake of my future patients. In groups of three or four, we learned everything from what to say ("You're going to feel the back of my hand now") to how to take off gloves (pointing toward the floor, just in case I fling it off) to how to perform the exam ("Turn your head and cough"). The order and flow of these exams is almost second nature to me, so it was intriguing to watch others learn. And, to be honest, there was a little feeling of schadenfreude when someone else fumbled. Having this opportunity is great so that we can ask questions and get any giggles out of our system before encountering actual patients. The male patient warned us, "You don't need to fill the awkward silence. Please don't say 'Looks awesome!' the minute I pull up my gown." That got a few laughs.

The rooms kind of looked like this, except the patients were healthy and on an exam table. (source)

Once, last year, I tried to engage in conversation with my standardized patient after the exam was over. I wanted to ask how he got into the field, what it's like to do all of this pretending, and what he really thinks of medical students. "I'm not at liberty to discuss anything past your exam," was the curt response I got. After this Saturday's very intimate examinations, I wanted to know answers to these questions even more. One journalist for Slate became a temporary standardized patient just to write about it. That essay is more of a reflection on how beginning medical students act. A more artistic writer, Leslie Jamison, wrote an essay about what it feels like to slip in and out of different personas. And finally, the medical journal JAMA published what sounds like a job description.

Just as there are a myriad of patients out in the world, the reasons why people become standardized patients are various. Some are grad students moonlighting for pocket money, some are unemployed middle-aged individuals needing some cash, and others are in it for the pleasure of teaching. Whatever the reason, here's a big thank you to all of the standardized patients out there for helping me become the best that I can be.