I recently read a hilarious article that was written by someone who spent some time acting as a “standardized patient.”  A “standardized patient” is someone who is paid to act as a patient so inexperienced medical students can perform histories and physical exams on them for practice.  The article shared some hilarious stories of medical students getting nervous, forgetting what they’re doing, and even getting a little out of line.  It got me thinking about my own experiences with standardized patients.

I’ve had the privilege to see five standardized patients so far in my short time in medical school.  I often wonder why anyone would be willing to be a standardized patient.  If not for the money, I think it must be for a good laugh because seeing a standardized patient can be one of the most awkward experiences ever.

The basic set-up is we are given a sheet with a name, a chief complaint, and a few vitals.  We have a set amount of time to see the patient, take a history, and perform a physical exam.  After the encounter the patient gets a few minutes to tell us how well or how horrible we did.  Then we write everything down in what is called a “SOAP” note that includes the subjective information (history), objective information (physical), assessment (diagnosis), and plan (treatment).

It seems easy enough, but for each standardized patient I’ve seen, I must say that as soon as I walk in the door, I immediately forget their name.  To this day I have never used the patient’s name to greet them.  When I walk in the room…I’m focusing 100% of my mental effort on trying to remember my own name, let alone the patient’s!  I always get so nervous before seeing standardized patients, even though the experiences are just pass/fail and you are given the option to remediate if you fail.

After performing my first physical exam, my patient commented that I need to wash my hands.  I am sure I looked like an idiot because I just sat there staring at my hands thinking, Are my hands really dirty or something?  It then hit me, Of course you wash your hands before touching a patient.  I  stopped being offended, and started feeling stupid.  I looked blankly around the room because I didn’t even know there was something to wash your hands!  Who knew?

My patient told me I was doing a good job, but I forgot a whole bunch of things…such as checking for tactile fremitus and a carotid pulse.  My problem is that I always get so nervous, and I don’t want there to be any awkward silences.  Our professors always tell us that if we forget what we’re doing we should just take their pulse.  But honestly, it would be a little weird if in the middle of taking a history I said, Excuse me while I take your pulse.

Taking a pulse is harder than you think.  So is taking blood pressure.  The good news is, you can just fake it.  Or at least I do.  Nobody is going to check, so I give it my best effort, and, in order to save face, only try one time.  I try reflexes twice before I give up.  I just nod my head and say, Looks good!  (But don’t worry, I would never fake it on a real patient!)

My least favorite part of the standardized patient experience is writing the SOAP note afterwards.  We haven’t quite learned enough to know how to diagnose and treat at this point, so I never know what to write down.  My patient is complaining of chest pain and a cough…sooo…diabetes?  I am always tempted to write for my “Plan” that the patient should “See a real doctor…”  

But, all in all, the standardized patient experiences are kind of fun.  It takes some getting used to.  After all, I didn’t go to medical school to learn acting, but the patients usually do such a good job, I really do forget they’re faking.

In case you’re interested in a good laugh, here’s a link to the aforementioned article:

Oh, no!  I’m the first patient these 23 medical students have ever examined

Here is also a link to a hilarious YouTube video about standardized patients:

M1 Patient Diagnosis