Emily Yoffe was online at Washingtonpost.com on Thursday, July 5, to discuss her adventures as Slate's Human Guinea Pig, the latest of which involved being examined by medical students. An unedited transcript of the chat follows.
Emily Yoffe: Hi, I'm Emily Yoffe, Slate's Human Guinea Pig. Today I'm going to be talking about my experiences as a "standardized patient," in which I volunteered to be examined by 23 Georgetown University Medical Students and lived to tell about it.
Seattle, Wash.: How did you find this job? It sounds like the perfect day job for me, but I e-mailed the local medical school (University of Washington) and they didn't seem to know what I was talking about. I even mentioned being an actor, and they didn't seem to think that qualified as "relevant experience". Is there some kind of central patient casting agency?
Emily Yoffe: Try this site: www.aspeducators.org, the association for standardized patient educators. They may be able to direct you to who at your local medical school handles standardized patients. Being an actor is very relevant. They look for actors!
Fayetteville, Ark.: As one of those "fifty-ish" physicians you mention in your charming piece, we did not learn on sample patients when I was in med school. Although it would no longer be considered acceptable and likely bred some bad habits, at my top-tier U.S. medical school we learned on living, occasionally breathing real patients. The motto was "watch one, botch one." With minimal supervision and no hidden cameras, we simply went to the ER at the adjoining public hospital and helped the residents clear out the chart rack of sick and injured patients that were crowding the emergency department. The budding surgeons helped put in IVs in the "knife ad gun club victims" seen in the trauma rooms and nascent gynecologists learned to identify the "PID shuffle" in the poor souls who had waited to treat their STDs until they could barely stand.
It was hardly a way to deliver quality health care or impart good clinical teaching and I trust that these experiences have largely gone the way of electro-convulsive therapy, but we came out of med school knowing which end of the otoscope was up.
Emily Yoffe: Thanks so much. For people who might stumble into emergency rooms today, I'm glad the system has changed. But medical students stumbling around inside innocent patients does make for good stories. I'm glad you think this new system is better. Some doctors think the way they learned was the best way.
Nashville, Tenn.: What was the funniest question a med student asked? Did you ever have to "break" character? Any residual pain from the experience?
Emily Yoffe: One of my favorite comments from the students was when one was testing the muscle strength of my legs and arms and after I pushed back really hard he said impressed, "Did you do sports when you were young—I mean NOW!" That made me feel old.
When the student took my bra off I did contemplate ending the exam, but I didn't want to get him in that much trouble, and I thought, "I've got to see how this plays out."
Harrisburg, Pa.: Did any of the 23 doctors observe anything that none of the others did not, and did this seem to be a worthwhile observation?
Emily Yoffe: One said I had "good mucosa"—which is something we all want to hear. I asked the doctor in charge what was the protocol if one of the students found something alarming and she said they weren't there to diagnose anything.
Chevy Chase, Md.: I am an aspiring doctor, and I would like to know what were some of the things that made you score some medical students higher than others.
Emily Yoffe: They got a high score if they didn't stab me with their instruments. Most of them were nervous (a few impressively confident and skillful) and I thought it was better for them to admit their nervousness than pretend they weren't. One who was shaking kept saying to me, "Relax, relax!" even though I was very relaxed.
I hope you follow your dream!
Boston, Mass.: I enjoyed your piece about being a patient. Have you read any of George Plimpton's experiential books (he went to the Detroit Lions training camp in one)? Where do you draw the line in experiences you won't try?
Emily Yoffe: I haven't read the books, although I remember him well. I should go look them up.
If you've seen the column, I don't draw too many lines -- I was a street performer at the corner of 18th and M in downtown D.C. I am, however, a physical chicken. No washing windows on a skyscraper.
Herndon, Va.: Ms. Yoffe: I admire you taking on the daunting task of submitting to 23 examinations by fledging doctors. Would I be right in assuming more of the males seemed uneasy than the females? I would think a "first" exam is tougher if the "patient" is of the opposite sex.
Emily Yoffe: I wondered myself if there would be any sex difference and surprisingly, there wasn't. Some of the women were extremely uncomfortable and had no idea how to handle the gown and drape. Some of the male doctors knew exactly what to do to maintain some modesty and also do a cardio exam.