“That sort of thing was somewhat stifled in a conservative bureaucracy,” he said. “I found it quite rewarding to be able to cut loose.”
Bell, 62, of Greenbelt, is one of hundreds of people in the Washington area whose day jobs are to realistically portray patients in medical cases. They are poked and prodded. They occasionally take off their clothes. Some even undergo breast and pelvic exams.
They come under the direction of medical school clinical directors, who act as casting directors, stage managers and dialect coaches rolled into one. With six major medical schools in the region annually training tens of thousands of students seeking to be doctors, nurses, pharmacists, social workers and other health-care professionals, demand for “patients” is high. Directors compete for those most likely to be convincing, take direction and show up on time.
The formal title is “standardized patient,” or SP for short.
Many are actors, but actors don’t always make the best patients, clinical directors said. Improv is not allowed. People trained to portray a particular type of patient must work from the same facts and deliver responses in the same way to the students examining them.
“They can’t overact,” said Kathy Schaivone, clinical instructor and director at the University of Maryland at Baltimore. “If I can’t guarantee that all five will cry, the ones that I know that can [cry], I have to ask them not to.”
Retired engineers and lawyers, abundant in the area, are good candidates because they can remember a wealth of information. Patients often have to recall up to 20 different items during the debriefing. Did the student palpate the sinuses? Listen to the heart in all four places? Wash hands before and after touching the patient?
“This is not like working as an extra on a movie, where you’re told to walk across the street,” said Mary Donovan, who handles the training at Georgetown University’s medical school.
At her desk, Schaivone is working the phone, on the hunt three months early to find teenagers for one case. ”They’re not a dime a dozen,” she explains.
Every few minutes, she jumps up and race-walks down the hall to manage a training session for first-year physician assistant students at Anne Arundel Community College. The men and women, in white coats, are waiting to enter five exam rooms to interview today’s “patient:” African American, high blood pressure, stressed from being laid off.
She fixes one man’s errant collar and signals them to start. “We’re going to hit it,” she announces over the loudspeaker. “Make sure you go in the correct room.”