After all that, in my post-drunk haze I started reflecting on the whole standardized patient experience, especially since my glorious medical school crams this stuff down are throats so much that, unlike just about every other medical school I have ever heard of (all of whom end these standardized patient experiences after the second year), they actually take us away from our clinical activities as third years (full of, dare I say it, real patients with real problems) to have us chat it up with a bunch of fake patients every few weeks. Why do they do this to us? How much does this cost? Why are my actors always so damn ugly? Am I really that pasty white in real life or just on video? The list of burning questions scorched through my forehead, much like the alcohol raged through my veins. (As an aside, my high school AP English teacher would be really impressed with that imagery and metaphor. Or is it an allusion? Simile? Ah, fuck it.)
At one point it finally occurred to me that while medical students are given volumes of instructional material on how to handle standardized patients, culminating in the USMLE Step 2 CS exam that we all must pass as yet another hurdle before being able to prescribe Vicodin to each other, there is really no standardized instructions for standardized patients (I get points for irony with that one, in case you’re keeping score) to follow in their quest to educate medical students.
However, fear not, for I am here to fill that void and enlighten you shining actors and actresses, you medical school players, you fantastic guildsmen and women of the arts. All you have to do is follow a few simple rules, and you too can become a standardized patient:
1. Don't Fuck With Me - Being a standardized patient means just that: you have to be...standard. Just like everyone else. In other words, stick to the script, asshole. I don't care what they taught you about expressing your inner self at Julliard, but when it comes to stuff like this, you better just play the role you were told to play and let us do our thing. If the script calls for pneumonia, don't play heart attack. If the script says you've had back pain for 15 years from a frightening toboggan accident, don't tell me you've only had back pain for 2 months and have never had any trauma in your life. If you can't even stick to the simple character sketch you were assigned, two things will likely to happen. The first, and less important consequence, is that the administrators are going to find out that you are so poor at your craft that you cannot even handle a job as pathetic, menial, and off-Broadway as that of a standardized patient at a medical school and fire you, marking the rather timely and fortunate end to your never-promising acting career. The second, and far more damaging consequence, is that you're going to make me look like an even bigger idiot than I already am as I present the false information you told me to my attending, only to find out that this was different than what everyone else was told by their standardized patients, making me look like a massive fool who still cannot even get a story straight after 2.5 years of medical school. By the way, that means YOU, back pain lady from this morning. Remember that part in the script about the toboggan accident that you failed to mention, even after I asked about a history of trauma? Could it have been anymore obvious? Toboggan ring a bell? Stupid bitch. Not that I'm bitter or anything.
2. Fuck With Me - This rule applies to the younger actors and actresses out there, those who are aspiring to reach the greatest heights of fame, glory, and assorted endorsements as they pursue a stunning acting career, equipped with a beautiful smile, a fantastic body, and the brain of a four year old. What better way to complement these features than by pairing your fine self with a strapping young future doctor at your side? Just thought I'd throw that one out there.
3. Over-do…Joke's On You - Contrary to popular belief, this isn't Masterpiece Theatre. This isn’t even your audition for the Akron Community Center production of Rent. You're performing live, one morning only...for a few lowly medical students, being recorded on a videotape that only the medical student will ever watch (if that - lets face it, the only thing worse than going through with this nonsense is watching yourself squirm through it on television later, although I bet you could come up with a great drinking game* for this. I'm really not an alcoholic.). In other words, you can hold off on the grand gesticulations, the exquisite elocution, and the pompous posturing that has gotten you this far as an actor, and instead just keep it simple. You may be able to stay in character as you thrash wildly around the room, writhing in pain and screaming in agony, all the while hoping that someone from William Morris Agency will see your gritty and over-the-top performance and get you a role in the next Spielberg flick. But all you're going to do is make some poor schmuck like me bust out laughing at you on tape over how ridiculous you are, and no one needs to see that. Just leave the over-acting to the professionals, you know, like Al Pacino and Paris Hilton. Wait, she’s really like that?
(By the way, the title of this rule totally rhymed, in case you’re keeping score)
4. In Character - Once you portray a patient with a certain disease, you're always going to be that patient to us even if, during another session, you are portraying a different patient with a different disease. This means that if you used to be breast cancer lady and now you are bladder incontinence lady, expect some moron from my class to ask you how your radiation and chemo have been going for no good reason. More importantly, this also means that if we see you on the street, we are, without a doubt, going to point at you and laugh. Yes, I'm referring to you, gonorrhea boy. That laugh I grace you with every morning as I walk by you and your valet booth on the way to the hospital is not of the casual "Hello" variety; it instead more closely resembles the "Dude, you totally had fake gonorrhea last week, and now you're working as an aspiring actor/valet" style.
5. Be Prepared - You may think that you are contributing greatly to the development of physicians everywhere, but, after the first one or two experiences with standardized patients as a first year (after which people start meeting real patients), this activity really starts to bore us to tears and loses any utility it may once have had. Which is why we keep on having to come up with new ways to make this otherwise painful exercise at least mildly entertaining. And as far as I know, the only useful method that has been developed thus far is the one where we do everything humanly possible to stretch your improvisation skills as far as we can, just to test your skills. This means you better know the names and professions of your second and third cousins, your sexual history while you were in college (in detail - we mean down to the specific brand of condom you used during the fourth drunken hookup in the winter of your sophomore year), and the frequency, color, consistency, smell, texture, taste, size, and shape of the last seventeen bowel movements you've had. Don't want to share? Sorry, this is for our medical education, and last time I checked we're the experts asking the questions, not you.
6. Respect - I know you're an amazing actor and everything, with a resume full of what I'm sure were spectacular performances in various local plays, failed auditions for Cheetos commercials, and a triumphant role as the tenth stand-by extra for a RuPaul music video in 1995 (I bet that name brings you back...probably back to some place you never wanted to go), but please remember that you're not the only person pretending to be someone you're not. Staring right at you are the sleepy, sad, and sometimes dreamy eyes of a medical student pretending that he or she is a real doctor, in a real clinic, evaluating a real patient as well. In fact, the only difference is that you are getting paid to be there, while we are...umm...paying for you to be there. So cut us some fucking slack, alright? If we ask about your fake problem, give us a little fake story to go by so we don't have to keep on asking more and more pointless questions. If not, see Rule 5 and be prepared to start answering questions about where your mouth has been lately. Jerk.
To the standardized patients of the world, I hope you have found this useful. To the current or budding medical students out there, I hope you have found that this at least partially reflects some of the information you wish you could convey to these actors. And, finally, to Natalie Portman, you can be my standardized patient anytime.
Now if you’ll excuse me, I’m going to go get wasted.
Standardized Patient Video Watching Drinking Game
Take a shot every time…
-You forgot to wash your hands
-You “accidentally” felt a boob while doing the cardiac exam
-You broke the exam table while trying to pull out the leg rest
-You demanded to actually do the rectal/breast/pelvic exam rather than accept their index card with the fake results
-You faked taking the blood pressure
-You faked any other part of the exam
-You finished 10 minutes before everyone else
-The actor went out of character
-The actor had dirty feet
-You had to touch the actor’s feet and pretend like it didn’t bother you
-You broke the fourth wall and winked at the camera
-You started laughing at the patient for no obvious reason
-You ran out of things to ask after about twenty seconds
-You referred to yourself as the "lowly" medical student
And finally, as the biggest no-no, take ten shots every time...
-You introduced yourself as “Dr."