Yes, I want to see more cross-pollination and artistic collaborations like Bedside Manner!

From the artist's website: "Bedside Manner is a series of photographs and an 18-minute video that explores the little-known world of standardized patient simulations. Standardized patients (SPs) are professional medical actors who are trained to present particular sets of symptoms in order to help medical students improve their diagnostic skills and bedside manner. Routinely, SP encounters are filmed and evaluated by medical professors who observe the interaction of student and medical actor through a one-way mirror."

I am delighted Corinne May Botz got permission for this series. Botz is also the author/photographer of "The Nutshell Studies of Unexplained Death," which explored the groundbreaking crime scene dioramas of Frances Gleaner Lee in the 40s and 50s.

I really wish I could watch the video, which doesn't appear to be available on her site or linked from the New Yorker. According to Botz, the video "deconstructs a real-life standardized patient simulation. It also creates a complex portrait of the neurologist Dr. Alice Flaherty, who plays herself as a doctor, standardized patient and real patient." Intriguing!

I think I am most interested in exploring this further: "...acting and staged representations inform the interaction between patients and doctors in important ways. In order to express their suffering, real patients must learn how to act in doctors' offices." This is very insightful. Reminding learners that patients are "acting," too, may be of use to them. The more learners are able to demonstrate empathy, validation, confidence, respect and autonomy, the less likely patients are to feel the need to "perform" to demonstrate their distress.

In fact, I am strongly reminded of a blog post called "Performance Anxiety" about how an obese patient feels the need to be "terrifically cheerful" in order to receive adequate care. "...being cheerful and upbeat simply works to get a better quality of care in almost every instance. But it’s also enormously taxing, because it is, after all, a performance. Going in for my ultrasound appointment, I was nervous as hell, but I also knew that as soon as I met with the wand-wielder I’d have to push all that worry away and take on a lighthearted, friendly, cheerful persona if I wanted to be certain I’d be treated like a whole person... this pressure to perform under what are at best extremely uncomfortable circumstances does add an additional layer of stress... I resent having to put this happy-fat-lady caricature on. But it’s the most reliable method I know for securing good customer service when I’m meeting a specialist or any new-to-me medical professional for the first time."

Wit

Happy holidays! Enjoy Emma Thompson in "Wit" while you're on break. "Wit" won the 1999 Pulitzer Prize for drama. It's funny and awkward and moving. Also: poetry! As someone who has done countless consent and DNR scenarios, this is a tough (but interesting! and powerful!) screenplay to watch; I can't imagine what it must be like if you have had cancer or lost someone to cancer.

Bonus gift: "UVM Medical Center hosts production of "Wit". SPs performing in a lecture hall! I wish I worked at an institution where this was possible.

"Wit," which won the 1999 Pulitzer Prize for drama, comes to Burlington thanks to another woman named Vivian — Vivian Jordan, a Shelburne resident who plays the lead role and whose profession merges the performing arts with the medical arts. Jordan works at the hospital as a “standardized patient,” which means she acts out roles for medical students learning how to diagnose illnesses. It brings awareness of end-of-life issues and spark discussion on the complex nature of dying in the Pulitzer Prize-winning play. 

New inspirations

Calliope, the muse of epic poetry, approves this post.
[La Muse Calliope via wikimedia]

This post original began as simply a grateful reference to Empathy 101 (how to sound like you give a damn), because I give similar feedback to learners. I nodded deeply in agreement when I read:

• "Reassurance often fails if the physician does not also communicate an awareness of the patient’s deepest fears or concerns." 
• "This model of doctor-patient communication begins with empathic listening and responding, requires reflectivity and self-understanding, and is in itself a healing act."
• The list of "Statements That Facilitate Empathy," which is a particularly useful tool.

But then I realized these quotes and tools are all by the same person, which is how I discovered Dr. Jack Coulehan. Coulehan has written both "Let Me See If I Have This Right… – Words That Help Build Empathy" for the Annals of  Internal Medicine as well as the textbook Metaphor and Medicine: Narrative In Clinical Practice.

Sadly, neither of those references appear to be available via my normal channels, but some of his other books are, and that's how I learned Coulehan is both a doctor and a poet!

For instance, in addition to his own poetry, Coulehan edited Chekhov's Doctors: A Collection of Chekohov's Medical Tales as part of the Literature and Medicine series. Perfect for actors, eh? The Kindle edition has a much more interesting description of it: "In his brief but distinguished life, Anton Chekhov was a doctor, a documentary essayist, an admired dramatist, and a humanitarian. He remains a nineteenth-century Russian literary giant whose prose continues to offer moral insight and to resonate with readers across the world. Chekhov experienced no conflict between art and science or art and medicine. He believed that knowledge of one complemented the other. Chekhov brought medical knowledge and sensitivity to his creative writing—he had an intimate knowledge of the world of medicine and the skills of doctoring, and he utilized this information in his approach to his characters. His sensibility as a medical insider gave special poignancy to his physician characters. The doctors in his engaging tales demonstrate a wide spectrum of behavior, personality, and character. At their best, they demonstrate courage, altruism, and tenderness, qualities that lie at the heart of good medical practice. At their worst, they display insensitivity and incompetency. The stories in Chekhov's Doctors are powerful portraits of doctors in their everyday lives, struggling with their own personal problems as well as trying to serve their patients. The fifth volume in the acclaimed Literature and Medicine Series, Chekhov's Doctors will serve as a rich text for professional health care educators as well as for general readers."

The intersection of art & science is one of my very favorite things. Looking forward to reading more work by Jack Coulehan.

Power ballads for mannequins

Are you an SP who works with mannequins? Then this unabashedly sentimental & irreverent video is for you!

Actor Seeks Role

All I can think of when I watch the SP-inspired "Actor Seeks Role" is how ironic it is that we work in the health industry but have so little access to health care:

This short film is much funnier and more tragic than when I wrote: "SP encounters are not a substitute for medical care." It's so easy to forget that SPs are considered temporary workers at best, and not eligible for the kinds of benefits other employees receive. Only one school I work with allows SPs to access medical care at their institution (which is, quite honestly, a big reason why SPs work at that school).

The Affordable Care Act really made a big difference in my ability to continue to contribute as an SP without living in constant fear of debilitating medical bills. I sure would like it better if schools were willing to include us on their health plans, though, or access to their care at a reduced rate.

Extra credit:
Of course, it's also charming to see how another SP studies, performs, and grapples with how to be a serious actor while being paid to be a pretend patient. Even while obviously exaggerated, it's certainly more realistic than that Seinfeld episode.

Playing Doctor

A first-year medical student examines an SP.
[The Young Doctor via wikimedia]

"Setting the Standard" might not exist if writing about the SP experience was more common. There are very few academic articles and even fewer personal essays. The few that do exist are single stories that generally approach the SP world from a outsider perspective, almost astounded: can you believe a job like this actually exists at your local medical school?

So I was delighted when I discovered the McSweeney's series "Playing Doctor" a few years ago. Robert Isenberg was the first author I found to write about the strange and wonderful complexities of being an SP in ways I recognized in my own life. I felt validated and inspired.

The Joys of Sickness & The Curious Case Of Trebor Grebnesi are the most spot-on at communicating the day-to-day experiences of SPs. As the series progressed I was looking forward to reading more. But my delight changed to sorrow when half the posts were suddenly removed and the series ended far too quickly.

Writing about your job on the internet carries inherent risks, and writing about students is twice as tricky. I'm a strong believer in boundaries. I believe in HIPAA and FERPA. But despite the care Robert apparently took ("all names, and many details, have been changed to protect student privacy") it wasn't enough.

So I am writing the blog I want to read. I hope to balance what is true for me with what is safe to write. But I also hope to find more voices and more experiences. I want to encourage SPs to write about what they know. I want to make a safe place for SPs to express themselves. If one of our primary skills is interpersonal communication, we need more of it, not less.