Louisville Magazine

AUG 2015

Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.

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60 LOUISVILLE MAGAZINE 8.15 unusual. And I thought the money sounded pretty good; those hot yoga classes I love aren't cheap. At times I've worked up to 20 hours a week and at other times I've gone a few weeks without working. SPs also have the opportunity to take themselves out of the scheduling pool for a while if they're busy with other jobs. Standardized patients' training begins with learning how to do a head-to-toe physical exam. We have to learn how it's supposed to go so we can evaluate students when they're examining us. We learn how students are supposed to take our vital signs, palpate our joints to look for creakiness (crepitus, to use the proper Latin term) and have us do simple tasks to make sure things are working neurologically. Tere are 142 steps in the head-to-toe exam, and there's a test on them that we have to pass. My now-husband became my practice dummy while I was studying. I don't think having me feel around for his thyroid and liver was his idea of a good time. After that, we start working with students. Sometimes SPs serve as instructional models. One day I lay on the table as frst-year students learned how to do a knee and shoulder exam. Tey'd move or poke at my joints, asking, "Does this hurt? How about this?" After having 10 or more students palpate your knee joint, it does start to hurt. But most of the encounters I've had are mock ofce visits with third-year students. Te kind that start with, "So, what brings you in today?" and end with a diagnosis and treatment plan. I play the same roles over and over again, but the variation between students keeps things interesting. Tis May and June, I played 17-year- old Hannah — who comes in with sharp, stabbing abdominal pain — approximately 52 times and each encounter was a little bit diferent. Some students seem like they've had years of practice interviewing patients about their symptoms and asking sensitive questions in a caring, friendly manner. Others seem nervous and fumble around for the right words. Some seem to forget that there's a person, not just a set of related symptoms, on the exam table gripping her side in pain. Most students ask me the same questions but in a slightly diferent order, so I always have to be alert. Tey ask things like: "When did this pain start?" and "Has anything like this ever happened before?" and "How would you rate your pain on a scale from one to 10?" Te answers to those questions are in the scripts, which also contain obscure details like what high school Hannah goes to, who her favorite teacher is and where she hangs out on the weekends. Only one student has ever asked me where I go to school, and I think he was just testing me to see if I knew. If I were to play that game called two truths and a lie, where you tell a group of people little pieces of trivia about yourself, one of my truths could be that I've had about 100 abdominal exams in the past year. Not many people can say that, right? Like their questions, the students' abdominal exams also vary. Some apologize for their cold hands. Some don't. Some have sweaty hands, but nobody's ever apologized for that. When they're pressing around on my midsection to get a better idea of where the problem is, some of them touch so lightly that I wonder how they'd feel anything if I were actually having problems. Some of them are aggressive and I want to reply "yes" when they ask me if certain parts hurt, even if my answer according to the script is "no." After each visit with a student, we evaluate and give feedback on their performance. Going down a checklist, we note whether they did basic things like wash their hands, introduce themselves and pull out the foot rest if they had us lie down on the exam table. We also give them a score between one and four on less concrete things like interest, empathy and respect. Tis is the most difcult part of the job. As Carol Williams, a long-time standardized patient who trained me for this job, put it, medical students like specifcs, and it can be tough to identify specifcally what a student did that made me feel their interest and empathy or lack thereof. Even though this is a side job, I feel like it's an important one. A recent U of L medical school graduate, in his frst weeks of a residency in internal medicine, told me that standardized- patient encounters are one of the few times future doctors really know how they did with regards to things like empathy and respect. (Since, you know, typically there are no comment cards in doctors' ofces or hospitals.) I know that visits with me and my fellow SPs are small parts of the students' training, and I sometimes get the impression that they're going to forget my comments as soon as they walk out of the room. But I'm hoping that if the situation does come up, they'll remember our encounter and be better equipped to help a real-life surly 17-year-old Jessica. One day I lay on the table as frst-year students learned how to do a knee and shoulder exam. They'd move or poke at my joints, asking, "Does this hurt? How about this?"

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