ndab Ah Yes, Medical School: Standardize Me

Friday, March 10, 2006

Standardize Me

This morning, after suffering through yet another standardized patient experience (where we are given clinical scenarios with actors mimicking symptoms and have to do a history and physical exam while being videotaped), I...umm...well actually I went to lunch and got completely drunk. Yes, it was 12:30 PM. I then staggered back to class and buzzed my way through another two hours of lecture, marking one of the most enjoyable drunken two hour lecture experiences I have ever had (let's put aside the "Hey lets take shots of Parrot Bay at 8:30 AM before Humbio core!" fiasco of '01 for just a moment).

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.

*Bonus Material!

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."


Blogger E :) said...

Take another shot every time the bad actor fakes another symptom that's not on the list...

11:01 PM  
Blogger Kate Mc said...

Enjoy the drunkenness and may your hangover not be too nasty in the morning.

You deserve it.

11:51 PM  
Blogger Sarah said...

always funny ...

12:11 AM  
Blogger Steven said...

Damn funny stuff. Hope the drinking sooths the pain.

4:12 AM  
Anonymous Anonymous said...

I'm a med student and having also experienced role-playing with actors for the purpose of developing my "communication skills," I thought I'd share it. My actor was actually amazing. He was playing a man with a wife dying from cancer with children who were finding it difficult to adjust and he actually broke down in the middle with real tears. I was blown away by the performance and even though I knew he was lying I swear on some level I believed him. So much so I felt desperately sorry for the guy and didn't want to end the consultation bcos I felt I hadn't been able to help him enuf, even tho I was going over time. I know he'll definitely always be on my list of "most memorable patients." Now to my point, these classes can help at least to experience things you won't get to for a while yet (not having graduated and all...) so you're not completely thrown in at the deep end when it does happen. And secondly, maybe your school should consider hiring British actors ;)

5:44 AM  
Anonymous Anonymous said...

I actually had to play this dumb game before being hired at work. It sucked then, but now I have the fun of "grading" newcomers when they do it. Karma is great!

6:04 AM  
Blogger gabbiana said...

One of the actors my school uses regularly will forever be known to me and my classmates as "Mrs. Rolardi," because that's who she played in this DRAMATIC interview with one of our instructors, and it was not entirely necessary to our medical education that she YELL and SCREAM and STOMP OUT at the news she had cancer, but she insisted when the MD was going to cut the exercise short... It's a year later, and I can barely interview her. Still, she's better than the obese man whose hairy boob I have to lift to listen to his heart.

The drinking game idea is brilliant. Now I finally know what to do with all the SP videos sitting around the apartment.

7:57 AM  
Blogger Margie the Pickle Princess said...

Um. . . darlin, if you're getting drunk at lunch, it may be time for an intervention. I'm just sayin.

8:59 AM  
Anonymous Anonymous said...

The standardized patients at my school are always forgeting their story and ad-libing shit instead. It's great when we're discussing the case in the group afterwards and everyone else got something important from the patient except me. Really, how hard is it for them to remember one page of info? I have to remember about 2-3 pages worth of questions to ask!

9:41 AM  
Anonymous Anonymous said...

OMG...the toboggan lady...that's gold.

4:30 PM  
Blogger Dana Lee said...

Hey, at least you guys get live fake patients. Our "education" involves stuffed animals.

5:45 PM  
Anonymous Anonymous said...

you should definitely get drunk before each of the lectures in the future and sit next to me again so we can just sit there going "mmmhmmm" over and over ;)

6:08 PM  
Blogger lucidkim said...

in college i tried to 'help' some social work majors by pretending to have problems so they could interview/intervene (whatever it is that social workers do) and i was too creative (my choice of words, not theirs) and they ditched me for someone else. :)

funny stuff. and something i would never have thought about...didn't know medical students spent so much time with pretend patients...


7:10 PM  
Blogger GP said...

Hay, I had to do it before and I believe this stupid `game' happens in most medical school. I was supposedly in for consultation with my fiance and we were asking questions on contraception and sex!! Imagine trying HARD to NOT laugh through that especially when the idiot who was my `other half' runs out of the given script and says "So dr we been practising the withdrawal method", looks at me and bursts laughing in front of everyone . . . Everyone was giving me free advice the entire week ... haaaa ...

12:01 AM  
Blogger Incommunicado Maxs said...

I had one "actress" who refused to answer any of my open-ended questions, and i had to probe like hell with all kinds of focussed and closed questions.

I asked, "Are there any concerns you may have that you would like to talk about?" She said no. Turned out that there was hell of a lot of stuff she was anxious about, but she simply refused to divulge it.

Needless to say, i was ticked off and i flunk the whole interview. I shall add that it was my exam (OSCE).

And the cruncher? The simulated patient dare say she felt comfortable relating to me. It was maddening. I felt like throttling someone.

5:02 AM  
Blogger "Jet" said...

That was some funny stuff there!!

Cheers to the drinking game!!


5:46 AM  
Anonymous Anonymous said...

As a second year, I've had the pleasure of telling a lady she was pregnant, even though her husband has been deployed for 10 months; that went well - especially when she refused to admit for 40 minutes that she's had sex with *anyone* but her husband. Bitch - follow the script

And I appreciated the guy with the neck pain who never uses his computer (oh, really?)

Or the woman with a chronic cough that never bothered to tell me she works at a soup kitchen no matter how many times I asked about other contacts who were sick.

"They" (those with the *long* white coats) tell us that this is because real patients do the same thing.... yeah, right.

7:41 AM  
Blogger Minstrel said...

Glad to see another post from you! Reading your blog takes some of the monotony out of sitting down at my computer every evening planning lessons.
Am a trainee teacher over here in the UK. Was thinking about making my blog into a trainee teacher's experience blog, but I haven't got half the amount of interesting stories the average trainee doctor has.

8:52 AM  
Blogger Amy said...

I'm a medical student who's quite new to this role playing thing but from what I've experienced you've hit the nail on the head!

3:21 PM  
Anonymous Anonymous said...

RuPaul? I think I might just get sick...

3:27 PM  
Blogger Lauren said...

Hmmm... maybe you're being too erudite... did you think about asking the toboggan lady if she'd been in any accidents or hurt herself in any way? Maybe she didn't understand what you meant by trauma! LOL I'm just sayin'...

6:55 PM  
Blogger Admin said...

OK fine, for clarity, my (almost) exact phrases included "Have you ever had this kind of pain before?", "Have you ever hurt yourself in the past?" and "Have you ever been in any accidents?".

In other words, she's still an idiot.

7:27 PM  
Anonymous Anonymous said...

A bunch of MS3s in MN just had an OSCE on Friday. Why does it always seem that when there are 45 seconds remaining and you are asking (for the 5th time) if they have any additional concerns today that they divulge they need help with ED and then the session os over before you know it. We went out for some beers following the exam, but it wasn't over until 5:00 pm. I can't blame you for tipping a few back...

9:43 PM  
Blogger Emma said...

"Um. . . darlin, if you're getting drunk at lunch, it may be time for an intervention. I'm just sayin."

Tee hee - student - even worse - med student! At least you got pissed *after* rather than before.

You may complain, but at least you don't spend your days looking at prehistoric charred seeds...

3:07 AM  
Blogger genderist said...

This is a hoot. I'll drink to that- bonus points included.

5:47 AM  
Blogger Twanna A. Hines | FUNKYBROWNCHICK.com said...

I *LOVE* midday drinking! :)

Hmmm ... standardized patients, you say? Who would have thunk it?

At least they're alive. A year or so ago, I read Stiff: The Curious Lives of Human Cadavers by Mary Roach. I got pretty freaked out.

6:21 AM  
Anonymous Anonymous said...

If you think standardized patients are a boring waste of your time, I seriously doubt you are ready to be unleashed on real live patients.

Sorry, I am not a member of your fan club. Your humor is sophomoric and often loaded with hostility. And please tell me you were kidding about getting drunk halfway through the day. You have some issues. Seriously.

10:53 AM  
Blogger Melissa said...


Just who in the world leaves a negative comment? A negative anonymous comment. What is THAT about?

Keep up the good writing. I like the burning questions scorching through the forehead bit.

3:29 PM  
Anonymous Anonymous said...

you took shots before humbio lecture too! i thought my friends and i were the only ones...

5:00 PM  
Blogger Admin said...

All comments appreciated...names, not so much:
From Karen, "that one is friggin hilarious. i was drunk at 6 pm friday...comparable?"

6:06 PM  
Blogger Admin said...

All comments appreciated...names, not so much:
From Anonymous, "Sorry, but I think this guy is in need of some tough love. Up until now his 'tude probably hasn't been a huge issue because his patients are a captive audience, so to speak.

Real-world patients are unfortunately going to be a lot less tolerant of his brand of humor, especially when it is directed at them. And some of them are going to complain, and hospital and clinic administrators tend to take notice of these things.

The drinking is a bigger concern. He hasn't responded yet, so I don't know if he was joking or not. Impaired physicians are not funny. They can injure and kill patients. They can be sued. Complaints filed with the medical practice board can result in having their medical license yanked. It's devastating and humiliating for the physician involved.

I sincerely hope The Fake Doctor will have a long and fruitful career. But his posts often sound angry and hostile, and it is concerning. The groupies here just seem to laugh and go along with it. You don't do your friends any favors when you only tell them what they want to hear."

6:07 PM  
Blogger Admin said...

All comments appreciated...names, not so much:
From Michelle, "In response to the "anonymous" comments....I think us uh, "groupies" understand The Fake Doctor's postings are meant in fun. I think most of us give him the benefit of the doubt that he takes medicine and patients more seriously in real life. I don't see anything wrong with finding the humor and irony in life's experiences, especially as a way to deal with the tremendous amount of stress in being a med. student. He is a great writer and very entertaining and funny. This latest post was a little hostile, however, everyone gets frustrated at times and venting helps. I don't see the problem since he doesn't disclose any names. I, too, hope that he doesn't have a drinking problem, but will give him the benefit of the doubt, since he says he doesn't. Don't stop writing, Fake Doc. You give us all the good laugh we need to lighten our own stress...just what the doctor ordered."

6:08 PM  
Blogger Sarah said...

oops, sorry fd

7:17 PM  
Blogger Daphnewood said...

aw, poor fake doctor! unfortunately, you are probably going to have real patients who do the same thing. maybe you can do your residency in margaritaville

ps. some people have no sense of humor. it's their loss

8:00 PM  
Blogger Emma said...

I don't know if it's just in the US where being a med student and getting drunk means you have a "problem"?? I'm astounded by how many people have commented on it and expressed concern!

Here in the UK it's well known that med students are the hardest partiers, but they're also the hardest working, and no one begrudges them having fun... I never ceased to be amazed by the slog my medic friends at my univeristy go through, and love them all the more for their seemingly tireless patience and being able to inject humour into what can be a thankless discipline.

I think people should recognise the strength of character required to be a doctor, which is clearly shown (again, I don't know what selection is like in the US) by how bloody hard it is to get onto a course, and also the drop out rate.

Of course if you were drinking before working a shift - there would be an issue, but I don't see how drinking before lectures calls for such a slating? At least you go to them!

Hmm... I seem to be having a rant day... apologies.

*Goes back to mindless procrastination*

7:12 AM  
Anonymous Anonymous said...

Oh, come on, people.

Do you honestly think this frat boy is for real? This is all just way too over the top. Someone is really getting his rocks off with all the attention.

I bet this whole blog is a fake.

8:42 AM  
Anonymous Anonymous said...

. . . and in a twisted reverse of the old and trusted game of "Playing Doctor", we now have "Playing Patient" ...

9:09 AM  
Blogger M to the E said...

At our school there is no time wasted when it comes to introducing its students to the standarized patient educational experience. My first, Nancy, was not a woman of many words, and prefered to only answer "yes" or "no" during her history...apparently, it was my job to guess all the details of her life and she would simply just agree or not. Bitch. And as for the foot exam part of the game...just to piss off my patient, I stopped before that part of the exam and put gloves on! I am not touching some old dude's crusty toes...keep that shit away from me.

11:01 AM  
Blogger design42 said...

I sympathise with your std patient excersizes and I'm sure I'll feel the way you do when I am faced with my own, but...c'mon, I haven't had a doctor yet that I've told the whole truth too. Purposefully or not, real patients lie.

11:31 AM  
Blogger Charity Leighta said...

Has anyone ever told you how much you sound like Zach Braff's character on "Scrubs"?

9:44 PM  
Anonymous Anonymous said...

This is definitely not a fake blog, to whatever idiot suggested it. As a med student trudging through my third year of school and first year of clerkship, I can attest that the amount of hilarious detail and pathos in this blog hits the nail right on the head. There is no way this could be made up - who the hell could come up with this stuff? I definitely couldn't have imagined it myself before I experienced it.

As to the appropriateness of the humour, Fake Doctor is just putting out there in public what me and all my med students friends do in private - bitch, moan, tell stories about our various nutty experiences, and tell jokes. Honestly, if I couldn't do that I don't know how I would survive it. Well, that and the occassional night of binge drinking. =) Seriously, let the poor guy blow off some steam.

And I hear ya about the standardized patients. At about the halfway point in first year they get really really tiresome. I can't believe your school makes you continue doing that shit in clerkship! What a colossal waste of time...

2:51 PM  
Blogger hotpink said...

Wow. Mr Negative Anonymous needs to quit taking himself so damn seriously. And get a life. And seriously, dude, look into that penis enlargement surgery, cause it'd be real nice for the rest of us if you had something to do in your spare time other than tearing funny people down.
Fake Doctor, Ive spent way more time in hospitals than I'd like, and most of it has been with doctors like ^that guy.^ Really really hope my next doctor is somebody like you.

10:04 PM  
Anonymous Anonymous said...

Wow. I don't know what to say. I guess I see both sides. I mean, I love humor. Whatever gets you through the stress and all.
As a patient? Hm. I had Hodgkins disease when I was 21. It totally sucked. I had chemo, rads, relapsed five months later and had a stem cell transplant. Did I mention it sucked? Most of the doctors and nurses were really great and very caring but some of the jokes bothered me.
Like, there was one time I was waiting for tx and a couple of nurses were in the med room and were all bitchy and sarcastic because one of the patients in the chemo room had vomited. They prolly thought I couldn't hear them talking. :( I know, I know, who likes cleaning up puke? But I'm sure the patient felt like cr@p too. I started getting really anxious that I was going to puke too, and then they'd be talking about ME. One of the hematologists I didn't like at all. He kept calling his patients "baldies" and I wanted to sock him. I cried when my hair fell out. :( I couldn't even look at myself in the mirror. Gee, thanks for rubbing my nose in it. I've also gotta say that when you're sick, the emotions are pretty close to the surface. I'm normally really happy-go-lucky, but I would cry and get upset about stuff that normally didn't bother me.
Why am I saying all this? I don't know. I guess sometimes humor is funny and sometimes it cuts like a knife, it all depends on your situation.

10:08 AM  
Anonymous Anonymous said...

Hey, IMO telling jokes and wacky stories are NOT for the patients to hear. I feel for you with the Hodgkin's, and I know exactly what you're talking about with that hematologist - I have shadowed or worked with many docs that think their patients appreciate their sense of humour. "Baldies"... yeesh, what a fucking moron. Believe me, I've wanted to punch a few docs in my short time in the hospital too, and that's from being on the other end of the exam table, without the complex emotional and psychological state of being a patient.

The jokes and stuff my friends and I engage in are stictly for our ears only. There is no bloody way I would act like that in front of a patient, and hopefully I won't ever get desensitized enough to forget how much I hate that sort of crap.

That's shitty that you overheard the nurses and it affected you like that. What a way to add to your already huge stress. I wouldn't realize criticize their attitude, since cleaning up puke does suck, but they definitely should have kept the volume down.

1:42 PM  
Anonymous Anonymous said...

It's me again, Hodgkins girl, LOL.

Thank you for the comments, MC, that was very sweet of you. I'm doing great, got back on track with college and have a really great life again. :)

I know that taking care of us is really hard. We're not pretty when we're sick! LOL. We appreciate what you do, believe me.

I guess it's hard for all of us to hang onto our humanity sometimes... we just have to keep trying, for our self-respect if nothing else.

That's all I wanted to say! :)

3:00 PM  
Blogger Kate said...


7:54 AM  
Anonymous Anonymous said...

A couple of things from another med student:

Funny writing. Very honest. I like it.

People need to get over themselves and realize that you are complaining about actors, not patients. The humor is warranted. These experiences are helpful because they help us to remember what things to ask, but that's about it. The rest is play-acting. Even when we have empathy, we have to be faking it since we're being empathetic towards FAKE COMPLAINTS!

We all go drinking at lunch occasionally. For people at my school, we have exams every Monday. Therefore, we have no weekend. Really... at all. Monday=the new Saturday. So... after our exam we go to a local restaurant and share a few beers. Not neccesarily drunk, but we definitely throw back a few. Will we do that after a tough shift at the ER? You betcha. Will we do it when we have to go back to the hospital? Hell no.

Just because our Monday is your Saturday, and I'm up studying while you're out partying (talking to the people talking at you about interventions) doesn't make me an alcholic. I have one chance to drink all week, and it's Monday at noon. Sorry.... only I'm not.

Keep up the good work!

Med students are people, too!

8:09 PM  
Blogger Mind Curry said...

like emma said, medicos in india are known to be the craziest party animals. i am glad that we follow the british system of education :) lol..the best days of my life have been the med school years.

absolutely hilarious writing doc!

2:20 AM  
Blogger thesleepystudent said...

Long time reader, first time commenter.
I have to come out in defence of the fake doc here. Standardized patients in third year seems pretty pointless, when you're surrounded with REAL ones. We even have mini exams on real ones. And I hated the standardized ones. And maybe the people critisizing the humour should realize that doctors are real people too, med students are, thats right, STUDENTS, and medicine isn't some sacred religion where everything and everyone is perfect. (Ooh, and read House of God, if you haven't. The Catch-22 of medicine.)

4:41 AM  
Anonymous Anonymous said...

can you be gay for me please ?

10:16 PM  
Anonymous Anonymous said...

hey this m3 in michigan still has standardized patient interviews. in fact, i have one tomorrow where i have to counsel someone on smoking cessation. wheeee! i've done cardiology and i've done vascular surgery - you think i can't talk about smoking cessation by now?

3:01 PM  
Anonymous Anonymous said...

My favorite med school drinking moment was when we all played flip cup in the student lounge which happens to be right in the hospital. I sooo wanted to walk down the hallways with my red keg cup in hand telling patients that I would in fact be their future doctor.

6:35 PM  
Blogger Febrifuge said...

Ahhh. So much fun. A couple things:

1) I just read something in (an admittedly last-year-ish) JAMA about how lame these standardized patient "encounters" are. I think the gist of it was, "wow, these suck, but I guess they're slightly above totally useless." I'm paraphrasing.

Basically, they're a great test... of your skills with standardized patients, which are indeed totally different from your skills with real ones. So they're like much of med school. Ba-dump-bump.

The grain of truth is that, yeah (and this is based on however-many thousand hours of shadowing and EMT work I've done), real patients *do* leave stuff out, forget things, self-contradict, and fail to answer the simplest of questions. Also they sometimes lie outright. For many reasons, very few of which are related to hostility or stupidity.

2) Speaking as a dude with a Theatre Arts degree, who is now heading into the medical-education meat grinder, my first day with a standardized patient is going to be the BEST DAY EVER.

Pt: "I, um, have this chest pain. It feels like--"

Me: "Bullshit. I didn't believe that for a second. What objective are you supposed to be playing? Are you trying to bring that weak-ass Uta Hagen crap in here? Are you? Huh? Oh, does this bother you? Criticism of your lousy technique? You want to cry? Yeah? Well, imagine that irritation you're feeling toward me is coming from your chest... Okay. Now do it again."


PS: I've linked to this from my blog, so expect four to six more hits. You've been warned.

6:58 PM  
Anonymous Anonymous said...

take a shot for learning to do the pelvic exam on a woman on her rag.

3:57 PM  
Anonymous Anonymous said...

I am so glad that I am not the only person in this world to be subjected to standardized patients. My paramedic class truly enjoyed your idea of a drinking game to go along with the videos. Thanks for the humor, it has made exam week a little more bearable

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1:38 PM  
Anonymous Anonymous said...

Amen. I just ran across your blog, and this really hits the nail on the head. We do Patient Based Assessments after most rotations, and they are consistently ridiculous. My real patients tell me they wish that I was their "real" doctor, and yet, my actors complain because they "had to turn their head to look at me." My personal favorite, though, was the fake ob patient who complained that her modesty was compromised during the fake pelvic exam when I didn't offer her a drape. It's ironic that she would say that when the actor never took her pants off the entire time!

2:40 PM  
Anonymous Anonymous said...

I won't criticize anyone for making fun of fake patients.. they would be not fun...can I please just ask that you remember when you deal with real ones that you really think about them. Please don't assume we are stupid people who deserve to be punished. Doctors may not like some patients, but sometimes there are reasons pts hate drs.

My sister went to a doctor complaining of exhaustion and numbness. She specifically expressed concern over her heart. The dr told her, you are a single mother, off course you are tired. She prescribed anti-depressants. My sister went to another doctor who LISTENED to her and felt it was easier to check and ease her concerns. My sister had a hole in her heart the size of a quarter and was in surgery 2 days later.

When I was in the army I had stomach pain that I clearly see was stress related. After the upteenth test for veneral disease, I asked why the repeated tests were necessary--I was told that I was government property and he could do what he liked to me. I was a virgin with an intact hymen--shoudn't have needed to test for VD over and over.

After an assault, I went to a shrink to deal with things...I was asked "were you REALLY raped, or did you just regret it?" Another told me to get over it when I cried at a follow up gyn apt.

My husband was accused of faking his illness by yet another doctor and was refused medical care with a threat to court martial him for malingering. We flew him to Mayo on leave and, HUGE Shocker...he was REALLY sick with a hernia.

I went to a doctor and told her both my ears had horrible infections and she asked me how I knew what it was in a VERY condescending way. Anyone who has EVER had an ear infection knows what they are...we are not stupid..

Thank you for listening--doctors who truly listen make the best ones. I think as bad as the fake pts are, it is because of bad doctors who have arrogant bedside manors that the rest of you pay. Please just remember we are humans when you deal with us.

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Anonymous Buy Tamiflu said...

Fake patients - it is really stupid. I don't think that you gain much experience during these exercises.

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