Patients Acting Standard

First off - TEST MONDAY!!!!!!!

So for interviewing class this week, we went to the Sim Lab (Simulation Lab) where we had our first Standardized Patient (SP) experience. Actors come in and pretend they are patients with problems. We will be using SPs for Interviewing and Physical Diagnosis practice before attempting on real patients. SP experiences are half fake and half real, because you are (usually, not this time though) being graded for your professionalism and competency, but the actors aren't really sick. It's almost a game because the point is to ask the right questions and do the right tests to figure out the problem and find a solution for the patient. Weird. But again, this experience was just for practice. So we were told to get the CC and the HPI for the patient. CC = Cheif Complaint. HPI = History of Present Illness. Gotta keep up with the lingo!


The HPI involves asking a series of questions about the CC. The mnemonic to remember when asking questions about a new complaint is FAR COLDER, which I could explain, but 1) I can't remember all of the questions, and 2) its basically just questions like what, where, when, how, why, for how long, etc.

But in (standardized) reality, when you just ask "Why did you come in today?" let the patient talk, then say "Tell me more about that..." the (standardized) patient will tell you most of the acronym up front. Then I can just get more info as needed without pestering them with tons of questions!!

I LOVED working with the SPs and here is a sample of the fake patients we got:

• An anxious law student with a mother with Alzheimers who isn't sleeping well
• An elderly woman with follow up for hip fracture who's husband just died. 
• A woman who is having blurry vision and has to urinate frequently.
• An 80 yr old man with a new sexual partner who wants more information on safe sex

Our interviewing group messed up a lot.  But we  got a sample of the different types of patients we may see, and will have lessons on how to handle each type (mental health, dying, crying, sexual health, bad habits, etc.). Also, all of the Boston schools share SPs, and they are super good actors. The anxious guy was so convincing. I love when they break character at the end and give feedback as themselves and you see how well they were acting like the patient! So here are a few things I learned:

• Blurry vision and frequent urination (do I talk about pee too much?) is probably indicative of diabetes...
• Don't forget to ask a patient's name, and always wash your hands when you walk in the room.
• Don't try to get stubborn people to change unless they are somewhat willing to!
  
• With mental health issues, there are a lot more mnemonics (SIGECAPS for general mental health issues, DIGFAST for mania)

I had the anxious patient and the diabetic for my two interviews (each 15 minutes long btw). I got great feedback - I apparently ask a lot of "multiple questions" Like "What is the pain like? Is it sharp or dull?" I should only ask one at a time, because multiple questions stress out the patients and they forget parts of the question(s).  I am great at creating rapport with the patients, and am a great active listener. I sometimes lose track of the point of the interview, but its ok because its usually to chat with the patient about their interests.

We didn't have any solutions for the problems because we haven't been trained on what to say / advise in these situations (yet), so the interviews were slightly awkward because we just asked a lot of questions and then didn't give advice. But I loved the experience and although in the future my experiences will be tested (aka way more stressful), I like working with the standardized patients!

I wanted this post to be way more entertaining, but I'm tired and don't have the energy to go back and make it clever, so it will have to do. Sorry!