LAS VEGAS, Nev. — Barb Morris has had shingles, carpal tunnel syndrome, heart problems, abdominal pains and pains in her neck, back and thighs. She has smoked, has drunk too much, has suffered depression and has used illicit drugs.
Now that we have your attention, let’s quickly add that none of that is even remotely true. Morris actually is a charming woman with an incandescent smile and a wonderful sense of humor who has done or suffered none of those things.
However, Morris also is an actress, and her ability to portray imaginary characters suffering from that depressing litany of medical maladies shows how talented an actress she is.
Morris is a member of Touro University Nevada College of Osteopathic Medicine’s cast of standardized patients. Several times a year, she and her fellow patient/actors willingly don those dignity-diminishing patient gowns, enter examination rooms at the university’s Henderson campus and patiently allow medical students to examine them for imaginary ailments.
The aim: to help Touro’s medical students become technically proficient and caring physicians. And, notes Dr. Ronald Hedger, assistant dean of clinical skills training at Touro University Nevada, the latter is just as, if not more, important as the former.
“The main reason that almost all medical students are going through this program is, about eight years ago, you saw patient complaints — their doctor wouldn’t listen to them or doesn’t care, doesn’t spend any time with them, are rude to them and so forth,” Hedger said. “So, in an effort to correct that, (medical) licensing boards have made it mandatory for students to take and pass this kind of examination in which they’re graded on humanistic characteristics.”
Touro has been using standardized patients since opening in 2004. Initially, the medical school recruited actors through the University of Nevada, Las Vegas’ theater program and trained them via a course that was offered through UNLV’s theater department.
Today, Touro has a cast of about 25 standardized patients, Hedger says, all of them actors and actresses — and a few dancers, too — and most of whom are members of the Screen Actors Guild. They receive $20 to $25 per hour for their performances, as well as the satisfaction of helping to train the next generation of physicians and (one would have to think) a seriously cool credit for their resumes.
Their work for Touro isn’t much different from any other acting gig. Each standardized patient receives a case study of the patient he or she will portray. They’ll then learn their characters’ family and medical histories, acquaint themselves with the medical condition they’ll be portraying and learn how to convey to the medical student the symptoms the condition would cause.
The conditions standardized patients act out are mostly “basic things students would see in a doctor’s office or an ER,” Hedger says — shingles, back pain and headaches, for example — and “we would have some people come in who would be extremely depressed or extremely argumentative.”
Medical students at Touro encounter standardized patients during their second year of studies. In most cases, Hedger says, the encounter marks “their first exposure to real people.”
Students have just 14 minutes to greet their patients, take a thorough family and personal medical history, conduct their examinations, diagnose what’s wrong and develop a treatment plan. Then, they’ll leave the room and have just nine minutes to write up their notes.
Students are evaluated on technical ability — how they handled the medical part of the encounter — and the way in which they interacted with patients. Hedger says that includes such considerations as whether they maintained eye contact with the patient and communicated effectively, whether they washed their hands when they entered the room and whether they draped the patient and took other measures to preserve his or her dignity.
This afternoon’s session will mark medical student Ori DeVera’s second encounter with a standardized patient.
“I did one about three weeks ago,” DeVera said. “We knew what to expect, but we didn’t know what to expect.
“We’re in there 14 minutes, and it’s amazing to see how fast 14 minutes can go by. And you have to do a complete physical exam and complete a history, and sometimes you have to do those at the same time. You have to be personable and have to smile and have to be a good listener, so that 14 minutes goes by pretty quickly. It’s amazing.”
The first time around, DeVera found it difficult to get the exam “back on track” after the patient offered him information in an order different from the order he planned to follow. Then, after leaving the examination room, DeVera realized that he had forgotten to ask the patient some pertinent questions.
This time, he says, “I want to make sure I don’t forget the same things.”
Patient/actor Morris learned about standardized patients from a newspaper item . At the time, she was retired from her special education job, in which she worked mostly with the hearing-impaired, and was participating in a senior adult theater program at UNLV.
“This is a marvelous program,” Morris said. “I feel privileged to be in it, because you’re teaching not only about people, but that (doctors) should have compassion and empathy and dignity for the person.”
Today, Morris will portray a woman with carpal tunnel syndrome. She notes that, while the actors do improvise at times, “you really have to stick by all the rules so it is standardized.”
She admits, too, that she sometimes feels bad when a student doctor isn’t quite getting to where he or she needs to go.
“You feel sorry for them, because they’re being tested,” she said. “But you can’t help.”
What was the most difficult condition she has had to portray? Morris thinks it over, then laughs.
“One time I had to portray a promiscuous woman. I told the student that I didn’t care who I went to bed with,” she said, delivering the line in a bored voice and with a dismissive wave of the hand.
Morris laughs again. “Oh, that took all the acting skills I could muster.”
Five minutes before the encounter begins, Hedger meets with his actors for a few last-minute notes and tips.
Responding appropriately to the medical student’s exam is crucial. Hedger says he may advise an actor that “when they push here, we need a painful response, or when they push you here, we need you to at least jump and tense. So they practice that.”
The patients head to their assigned examination rooms. Another minute or two passes when Hedger announces, “Actors stand by,” over the PA system, followed a few minutes later by the entrance of a group of white-coated medical students, all of them intensely focused, none of them uttering a word. Each signs into the notebook computer positioned on a shelf outside each examination room and, upon Hedger’s cue, enters.
It’s showtime, and never has the theatrical good-luck offering to “break a leg” seemed more appropriate.
As the students begin their examinations, Hedger watches in an office equipped with a large-screen TV. Each examination room is outfitted with two cameras and audio, so Hedger can watch and listen to what’s going on in every room at once or zoom in on a specific room.
DeVera’s patient today is “Bobby Downe,” identified on the video screen as a 48-year-old complaining of “right-sided hand discomfort.” In real life, she’s Maythinee Washington, who earlier this year returned to Las Vegas from London after studying for her second master of fine arts degree, this one in acting for the screen.
It’s Washington’s first performance as a standardized patient. She notes that the gig is pretty much like any other acting job, in that patients portray “a real person” built upon the case studies they have received.
DeVera spends the first one-third of his allotted time taking a history from Washington, then begins the physical exam. By six minutes and 30 seconds into the exam, he seems to be zeroing in on Washington’s hands and forearms, asking her to bend her hands this way and move them that way, waiting for her to respond with feigned pain.
It’s bizarre how a routine medical exam that would be boring in real life takes on the excitement of a reality show when viewed live on a TV screen.
When DeVera tells Washington with just a few minutes to spare that he suspects a repetitive stress injury, it’s difficult, watching in the control room, to not pump a fist in the air and yell, “Yes!”
DeVera explained to Washington what’s probably causing her pain and suggests a treatment routine that includes icing and heat. When Hedger finally calls time, the students leave their examining rooms and begin busily writing their notes.
Afterward, DeVera says he knew early on in the exam that Washington/Downe probably was suffering from a repetitive stress injury. She also had mentioned during the exam that she was worried that the numbness she felt might be the result of a stroke. DeVera says he thought that unlikely. But because he didn’t want to dismiss her concern out of hand, he spent a minute or two explaining to her why that probably wasn’t the case.
In retrospect, DeVera added, “if not for the time, I would have evaluated her neck more,” because the pain Washington was portraying also could be related to a slipped disk, a bone spur or a problem with nerves around the shoulder.
Doctor and patient give one another high marks. “She was a very good actor,” DeVera said, while Washington compliments DeVera for having “a really good bedside manner.”
She smiles. “The last time I went to a doctor here in the U.S. (that) was kind of not so.”
Each student’s performance will be evaluated. But Hedger is pleased with the improvements he sees over the students’ first encounters.
And, at the other end of the doctor-patient continuum, “I’m so impressed with these standardized patients,” Hedger said. “They have to perform at the top of the heap, and they’re just great.”
Washington enjoyed her first experience, too, calling it “fun and immediately useful.”
Most of all, the whole thing seems reassuring somehow, in that no matter how much health care might change or how high-tech medicine might become, it all still comes down to a doctor and a patient interacting in a room.
Hedger would agree. And, he added, “it always will.”
• • •
John Przybys is a feature writer at the Las Vegas Review-Journal. Contact him at jprzybys@ reviewjournal.com