WEBVTT - How Standardized Patients Work 0:00:00.240 --> 0:00:03.240 Hey, everybody, it's us Josh and Chuck, and we want 0:00:03.240 --> 0:00:06.200 you to know we are coming somewhere near you. We're 0:00:06.320 --> 0:00:10.320 sure if you live in North America this year, that's right, 0:00:10.360 --> 0:00:12.800 We're going on tour, and uh, why don't we just 0:00:12.880 --> 0:00:16.600 rattle through these dates? Okay? Uh? Toronto August eight at 0:00:16.600 --> 0:00:19.919 the Dan and Fourth Music Hall, Chicago August nine, the 0:00:19.960 --> 0:00:22.599 next day at Harris Theater. Then we are taking some 0:00:22.680 --> 0:00:25.720 time off to recover after that two day grind. We're 0:00:25.720 --> 0:00:30.760 eating Vancouver the Vogue Theater September twenty six, followed by Minneapolis. 0:00:30.800 --> 0:00:33.360 We're gonna be at the Pantageous Theater again on September 0:00:34.479 --> 0:00:37.480 that is correct, yep. And then Austin Chuck on October 0:00:37.520 --> 0:00:41.680 tenth of the Paramount Theater, Yes, and very special show 0:00:42.120 --> 0:00:45.839 and Lawrence Kansas at Liberty Hall on October eleven, yep. 0:00:45.920 --> 0:00:48.720 And then we're gonna do a three night stand October 0:00:48.720 --> 0:00:53.840 two at the Bellhouse in Brooklyn, New York. And then Chuck, 0:00:53.920 --> 0:00:56.560 take it home. Uh, well take it home literally, because 0:00:56.600 --> 0:00:59.560 we are finishing up November four right here in Atlanta 0:00:59.560 --> 0:01:02.280 at the Bucket Theater and this is a very special 0:01:02.280 --> 0:01:05.560 benefit show. Uh, and all the Proceeds will be going 0:01:05.600 --> 0:01:09.160 to Lifeline Animal Project of Atlanta and the National Down 0:01:09.360 --> 0:01:13.120 Syndrome Society YEP. And for more information in DWO buy tickets, 0:01:13.200 --> 0:01:17.240 just go to s Y s K live dot com. 0:01:17.280 --> 0:01:20.440 Welcome to stuff you should know. I'm from House Stuff 0:01:20.480 --> 0:01:29.960 Works dot com. Hey, welcome to the podcast. Blame is 0:01:30.040 --> 0:01:34.280 Josh Clark, and I'm proud to introduce my partner co 0:01:34.400 --> 0:01:39.040 hosting Crime, one of those two Mr Charles W. Chuck 0:01:39.319 --> 0:01:45.600 Wayne Chuck Tran Bryant Chuck Tran yep. And this week, Chuck, 0:01:45.680 --> 0:01:49.520 we have a very special guest producer filling out the seats. 0:01:49.640 --> 0:01:56.160 Right is the rump of Noel around. Yeah, Jerry's she's 0:01:56.200 --> 0:02:02.680 at the beach because she needs a vacation. I'm good, guys. Yeah, 0:02:02.880 --> 0:02:05.040 Jerry's romping at the beach with her wife and her 0:02:05.120 --> 0:02:09.600 daughter and a bunch of friends. And you know, I 0:02:09.600 --> 0:02:17.280 think that sounds lovely. Well, yeah, the beach rocks. Even 0:02:17.360 --> 0:02:20.200 Miley Cyrus likes the beach. Now, I don't get it. 0:02:20.880 --> 0:02:23.359 She's got this new single out about how her boyfriend 0:02:23.360 --> 0:02:25.600 introduced her to the beach. Is pretty sweet song. Actually, 0:02:25.800 --> 0:02:29.320 you know this stuff? I just I my my wife 0:02:29.680 --> 0:02:33.040 produces me to think sometimes each otherwise would never ever 0:02:33.160 --> 0:02:35.440 have come across like, I can pick on you for that, 0:02:35.480 --> 0:02:36.920 but I would never pick on you me for that. 0:02:37.840 --> 0:02:40.440 You know, what, are you a monster? You know? Pick 0:02:40.480 --> 0:02:44.880 on a man's wife? Right? So, yeah, it is a cute, cute, 0:02:44.880 --> 0:02:47.120 sweet song. Though I can I can give it a 0:02:47.160 --> 0:02:50.360 hearty endorsement. Emily has her little secrets to from even me. 0:02:50.480 --> 0:02:52.239 She's she singing this song the other day that was 0:02:52.280 --> 0:02:54.960 on some TV show. I was like, how do you 0:02:55.000 --> 0:02:58.959 know this? I've never heard the song, and she said, no, 0:02:59.000 --> 0:03:01.920 you know it's a song. I know what song. I 0:03:01.919 --> 0:03:03.240 don't even know what it was. It was just some 0:03:03.360 --> 0:03:06.000 kind of bubblegum poppy thing you don't and that's kind 0:03:06.000 --> 0:03:08.800 of not her. But you never you never know, you know, 0:03:09.639 --> 0:03:16.520 I might have a fromer boyfriend, s Todd Todd Hodds 0:03:16.520 --> 0:03:19.880 into bubblegum pop. He's a jerk, he's got frosted tips 0:03:19.919 --> 0:03:26.000 on his hair, he's got a severe embre. So which 0:03:26.000 --> 0:03:30.400 one are we doing? We're gonna do standardized patients and um, 0:03:30.440 --> 0:03:33.880 it's funny. The the thought occurred to me to go 0:03:33.960 --> 0:03:37.320 through this entire episode without mentioning sein felt at all, 0:03:37.960 --> 0:03:40.760 just to make people really angry. Man. We would have 0:03:40.760 --> 0:03:43.600 gotten so many emails though. But that's kind of like 0:03:43.800 --> 0:03:48.040 you can't not mention the very famous Seinfeld episode where 0:03:48.120 --> 0:03:53.000 Kramer and uh, who's the other guy, Mickey? Oh? Yeah, 0:03:53.040 --> 0:03:55.800 I forgot Mickey was one too. Was that his name? Yeah, 0:03:55.840 --> 0:03:58.320 it's his friend who was a little person. Yeah, and 0:03:58.360 --> 0:04:01.680 they they were. I think Mickey got him into it, 0:04:01.760 --> 0:04:03.760 and they were they were And I didn't even know 0:04:03.800 --> 0:04:05.840 they were called standardized patients. I doubt if they said 0:04:05.840 --> 0:04:08.840 that on the episode. I don't remember what they called them. 0:04:08.840 --> 0:04:12.160 They surely they call them something. Well, they have a 0:04:12.160 --> 0:04:16.920 few names, simulated patients, standardized patients, care actors. Well, there, 0:04:17.040 --> 0:04:19.720 those are. Some of those are different. They're they're generally 0:04:19.760 --> 0:04:23.040 the under the umbrella of say like a simulized or 0:04:23.080 --> 0:04:27.720 stand simulated patient, but they're slightly there's little nuances there 0:04:27.760 --> 0:04:32.039 that that make the whole thing revolting, lee fascinating. Programmed 0:04:32.040 --> 0:04:34.600 patients and that what the first guy called it. Yeah. Man, 0:04:34.800 --> 0:04:37.240 if that's not like a brain doctor's name for it, 0:04:37.320 --> 0:04:41.960 then I don't know what. Uh, well, should we start there. Yeah, 0:04:42.040 --> 0:04:45.120 let's go back to that guy, a doctor named Howard Barrow. 0:04:45.680 --> 0:04:48.839 He worked out at USC Ego Trojans and he was 0:04:48.920 --> 0:04:52.240 teaching back in the early sixties, late fifties, I believe, 0:04:53.080 --> 0:04:56.680 and apparently at the time, Chuck, they would just teach 0:04:56.720 --> 0:05:00.120 you everything and then say, okay, you've graduated, your going 0:05:00.200 --> 0:05:04.240 goodbye to practice medicine. Good luck with a live human exactly, 0:05:04.600 --> 0:05:09.359 you've never encountered one throughout your entire training, but you're 0:05:09.360 --> 0:05:13.279 a doctor now, so we we wash our hands of you. Right. 0:05:13.800 --> 0:05:17.920 And so this guy was teaching neurology and realized, like 0:05:18.680 --> 0:05:21.760 I think he had a friend who had come to 0:05:21.760 --> 0:05:26.200 to start like observing his graduates in a clinical setting, 0:05:26.480 --> 0:05:29.359 but like after they graduated and we're practicing doctors and 0:05:29.400 --> 0:05:31.160 we were like whoa, well, whoa, you guys are doing 0:05:31.200 --> 0:05:35.560 this all wrong. Who taught you this? And like you did? 0:05:36.240 --> 0:05:38.440 And uh, He's like, all right, well, we gotta do 0:05:38.480 --> 0:05:41.880 something different. So that doctor figured out that he could 0:05:41.920 --> 0:05:46.120 sit down and go through basically observe a doctor doing 0:05:46.800 --> 0:05:50.520 an entire patient history and exam and everything. But each 0:05:50.560 --> 0:05:52.560 one took like two to three hours, and they're like, 0:05:52.600 --> 0:05:54.960 there's gotta be a better way to do this. So 0:05:55.120 --> 0:05:59.160 Barrows was it was his idea, and his idea alone. 0:05:59.240 --> 0:06:02.680 Right from what I understand I saw, I came across 0:06:02.720 --> 0:06:09.359 another doctor, a woman pediatrician, woman named Paula's Stillman, who 0:06:09.520 --> 0:06:12.800 came up with this idea also seemingly independently in the 0:06:12.880 --> 0:06:16.680 early seventies. Um, because it didn't catch on big time 0:06:16.720 --> 0:06:19.280 in the eighties. So I think she am Barrow are 0:06:19.360 --> 0:06:22.479 kind of like the earliest practitioners of this thing. Well, 0:06:22.520 --> 0:06:25.320 it wasn't a big hit at first, Like people kind 0:06:25.320 --> 0:06:27.320 of made fun of them, uh. I know in this 0:06:27.440 --> 0:06:31.000 one article you found they there were newspaper articles, one 0:06:31.040 --> 0:06:33.799 in the l A Herald Examiner that had a headline 0:06:33.800 --> 0:06:38.000 that said Hollywood invades USC Medical School. Uh. In in 0:06:38.040 --> 0:06:41.920 the San Francisco Chronicle, of all places, they said scantily 0:06:41.960 --> 0:06:45.400 clad models were making life a little more interesting for 0:06:45.440 --> 0:06:49.320 the USC medical students, which is really I mean, I 0:06:49.320 --> 0:06:52.440 guess it's a sign of the times, but really kind 0:06:52.440 --> 0:06:55.520 of a crappy way too. You know, they made it 0:06:55.560 --> 0:06:59.080 sound like it was some titilating sexual thing, right, because 0:06:59.160 --> 0:07:03.159 you know, they had these people that are really doing 0:07:03.200 --> 0:07:07.400 what you know, what I learned was a super valuable service. Well, yeah, 0:07:07.480 --> 0:07:10.880 for sure, I think they were just trying to sex 0:07:10.920 --> 0:07:12.440 it up for the paper. You know what I mean, 0:07:13.040 --> 0:07:16.680 they're reading audience because they were like Zodiac Killer coming soon, 0:07:16.840 --> 0:07:21.440 what's that stay tuned? But he wasn't around yet, so 0:07:21.440 --> 0:07:23.080 they had to do something. So they were just trying 0:07:23.160 --> 0:07:25.920 to take something that was actually, yeah, a valuable service 0:07:25.920 --> 0:07:29.680 and pretty straightforward and again sex it up a little bit, 0:07:30.320 --> 0:07:33.280 but it actually it kept it from catching on for 0:07:33.320 --> 0:07:35.360 a while, at least at first. It wasn't until I 0:07:35.400 --> 0:07:38.280 think the mid eighties that Barrow was able to like 0:07:38.360 --> 0:07:43.280 get it to start to become adopted throughout the the 0:07:43.280 --> 0:07:46.360 the medical universe and the United States at least. Yeah, 0:07:46.400 --> 0:07:49.280 and you know what, we've done that thing again. Yeah, 0:07:49.280 --> 0:07:51.680 I know where we haven't said what it is yet. 0:07:53.200 --> 0:07:56.280 You had to have seen Seinfeld and know how to 0:07:56.320 --> 0:07:59.000 read between the lines of our conversation. Yeah. So a 0:07:59.080 --> 0:08:03.360 simulated patient or a standardized patient is um Sometimes you're 0:08:03.360 --> 0:08:07.320 an actor. Sometimes they have no acting experience. Sometimes it 0:08:07.320 --> 0:08:10.040 we'll get to who these people are, but they're generally 0:08:10.240 --> 0:08:12.800 people looking to make a buck, who are who fit 0:08:12.880 --> 0:08:18.240 the profile and of being a fake patient to a 0:08:18.240 --> 0:08:22.520 medical student so they can get a real practical human 0:08:22.560 --> 0:08:28.000 to human experience in medical school exactly because there's a 0:08:28.000 --> 0:08:32.600 big difference between book learning in real life, right, and 0:08:32.640 --> 0:08:37.200 if you're a doctor, a huge, huge part of your UM, 0:08:37.280 --> 0:08:44.199 your job, especially UM non surgical doctrine is conversing with 0:08:44.280 --> 0:08:49.440 a human being patient and and on the one hand, 0:08:49.480 --> 0:08:52.280 treating them as a human being, not a set of symptoms. 0:08:52.280 --> 0:08:56.400 That's a big one. But then also um, getting out 0:08:56.440 --> 0:08:59.400 of them what's wrong with them so that you can 0:08:59.440 --> 0:09:03.200 diagnose them. Yeah, that's I thought this was all sort 0:09:03.240 --> 0:09:06.520 of just about bedside manner and like being you know, 0:09:06.960 --> 0:09:08.440 because it's a big part of the job. You know, 0:09:08.520 --> 0:09:11.160 you want a doctor. If you've ever had a doctor 0:09:11.200 --> 0:09:13.240 that had a poor bedside manner, you know what I'm 0:09:13.280 --> 0:09:16.360 talking about. UM, If you haven't, then you might take 0:09:16.400 --> 0:09:18.320 it for granted that everyone's like that, but that's not 0:09:18.400 --> 0:09:20.560 the case. But the second part of that I didn't 0:09:20.559 --> 0:09:23.960 really think about. But um. The director of the Standardized 0:09:23.960 --> 0:09:28.360 Patient Program at University of Pittsburgh School of Medicine, Valerie Former, 0:09:28.400 --> 0:09:30.360 who they don't know if they interviewed her for this 0:09:30.559 --> 0:09:33.160 or if she was just they pulled some quotes, but 0:09:33.760 --> 0:09:35.920 I never really thought about it. She said, communication is 0:09:35.920 --> 0:09:39.320 at the root of proper diagnosis, patient safety, and patient 0:09:39.400 --> 0:09:42.800 satisfaction and miscommunication can lead to medical error, so they 0:09:42.840 --> 0:09:45.240 have to A big part of the job is drawing 0:09:45.240 --> 0:09:47.760 out of the patient what the heck is wrong with them, 0:09:47.760 --> 0:09:50.439 because they can examin until the cows come home, but 0:09:50.480 --> 0:09:54.000 they need words, right, So like, yeah, patient who comes 0:09:54.040 --> 0:09:57.760 into the doctor's officer, that e er isn't gonna be like, um, 0:09:57.800 --> 0:10:00.720 I have an abscess on my right kid. Need that 0:10:00.840 --> 0:10:03.480 needs to be treated or else I'm gonna die of 0:10:03.520 --> 0:10:06.640 sepsis in the next twelve hours. Is my my my 0:10:06.800 --> 0:10:09.839 side hurts, That's what you get. So you have to 0:10:09.880 --> 0:10:12.720 ask more questions and know what questions to ask. So yeah, 0:10:12.720 --> 0:10:15.520 it's it's diagnosis, learning how to diagnose from talking to 0:10:15.559 --> 0:10:18.120 people in drawing info out of them. But that bedside 0:10:18.120 --> 0:10:21.439 manner that's not to be overlooked, Like that's a big 0:10:21.520 --> 0:10:24.440 part of it because you know, if if people start 0:10:24.520 --> 0:10:27.920 to think every doctor I've ever interacted with treated me 0:10:28.000 --> 0:10:30.360 like I was just a bag of organs and bones, 0:10:30.880 --> 0:10:33.920 which we couldn't couldn't sure, and couldn't care. But you're 0:10:33.920 --> 0:10:37.400 not supposed to to let on that every like we 0:10:37.480 --> 0:10:40.559 all have to pretend in this big grand manner, right exactly, 0:10:41.000 --> 0:10:43.600 And but it will keep you from going to the doctor. 0:10:44.559 --> 0:10:46.280 And if you stop going to the doctor, and then 0:10:46.320 --> 0:10:49.680 health problems can can start to accumulate, and it's all 0:10:49.720 --> 0:10:53.600 the doctor's fault for being a sociopathic jerk. Well yeah, 0:10:53.679 --> 0:10:56.360 but you also you know in that um which one 0:10:56.400 --> 0:11:00.719 were we talking about doctors being too empathetic? The empathy one? 0:11:01.480 --> 0:11:04.000 Oh yeah, okay, there you have it. You didn't want 0:11:04.000 --> 0:11:06.520 to dr fell to pieces. No, you you need to 0:11:06.600 --> 0:11:09.640 learn to walk that fine line between being too clinical 0:11:09.840 --> 0:11:13.040 and too much of an EmPATH to where the patient 0:11:13.080 --> 0:11:16.640 feels eddies and taking care of but you feel confident 0:11:16.760 --> 0:11:20.199 and they're not like breaking down and crying because they 0:11:20.200 --> 0:11:23.319 have to tell you that you may be dying. Let's say. Yeah, 0:11:23.360 --> 0:11:26.319 but the the lady from the University of Pittsburgh who 0:11:26.400 --> 0:11:28.960 was interviewed in this article points out that there was 0:11:29.440 --> 0:11:32.280 she she remembered at least one medical student who did 0:11:32.600 --> 0:11:37.160 break down because of an interaction with a simulated patient 0:11:37.320 --> 0:11:42.120 or standardized patient. UM and that that that that's the 0:11:42.200 --> 0:11:45.720 point of a similizer or simulated or standardized patient is 0:11:46.400 --> 0:11:48.360 so that you can go ahead and break down like 0:11:48.440 --> 0:11:52.120 that and get it out UM In in a basically 0:11:52.160 --> 0:11:54.960 a classroom setting, so that when you encounter this in 0:11:55.000 --> 0:11:58.480 the real world, you'll have already gone through that. Yeah, 0:11:58.559 --> 0:12:01.440 and um, we'll get into the nuts and bolts of 0:12:01.480 --> 0:12:04.960 it in a bit. But um, if you're wondering if 0:12:05.000 --> 0:12:06.960 you want to go do this, if you have to, 0:12:07.080 --> 0:12:11.120 like you know, get a prostate exam. Um, you don't 0:12:11.160 --> 0:12:13.280 have to, but if you're if you're open to that 0:12:13.400 --> 0:12:17.240 kind of your intention, you can sign up for a 0:12:17.240 --> 0:12:20.800 more intense uh and I imagine those are the ones 0:12:20.840 --> 0:12:23.280 that pay a little bit better. But you can go 0:12:23.320 --> 0:12:25.920 in and volunteer for a prostate exam or or or 0:12:25.960 --> 0:12:29.400 breast exam or anything that involves something a little more 0:12:30.240 --> 0:12:34.840 uh um invasive. Yeah, but you're not gonna get cut 0:12:34.960 --> 0:12:37.760 or you're not gonna get a needled or anything like that. 0:12:37.800 --> 0:12:40.000 They're not going to practice that kind of stuff on you. Right. 0:12:40.040 --> 0:12:42.239 I was reading the f a Q on the University 0:12:42.240 --> 0:12:46.400 of Pittsburgh site about their um simulated patients, and they 0:12:46.480 --> 0:12:51.040 point out that patients simulated patients will not be given drugs. Yeah, 0:12:51.080 --> 0:12:53.319 then that can inject you with like a cocktail of 0:12:53.360 --> 0:12:57.319 antipsychotics and stimulation, and this may be a good way 0:12:57.320 --> 0:13:01.040 to score, right, But it's on you, is the simulated 0:13:01.080 --> 0:13:06.520 patient to um to act as if you're um going 0:13:06.520 --> 0:13:09.679 through a psychotic break right there. Yeah, potentially so that 0:13:09.720 --> 0:13:11.600 the doctor can learn how to deal with that kind 0:13:11.600 --> 0:13:14.800 of thing. That's probably one of the more dramatic examples. 0:13:14.960 --> 0:13:16.920 I think a lot of them are a lot more pedestrian, 0:13:17.240 --> 0:13:20.040 but that is definitely in the mix as well. Well. 0:13:20.080 --> 0:13:24.679 Even though you're as we'll see, it's you sort of, Um, 0:13:24.720 --> 0:13:27.679 it's not scripted. You do have to be an improviser 0:13:27.720 --> 0:13:30.520 of sorts, but you're supposed to stick to kind of 0:13:30.880 --> 0:13:32.400 I don't think you're supposed to throw them any just 0:13:32.520 --> 0:13:36.520 curveballs that you think of in the moment, uh, which 0:13:36.520 --> 0:13:38.440 is what I would want to do, which is probably 0:13:38.760 --> 0:13:42.559 I would not be a good sp That's what Kramer did. Yeah, 0:13:42.559 --> 0:13:44.560 he he could have made it into like a real 0:13:44.600 --> 0:13:48.760 acting gig, right right. And they say that actors can 0:13:48.840 --> 0:13:52.240 be good at this, but it's not acting, like they 0:13:52.360 --> 0:13:56.240 point out that, Um, there's no you're not searching for 0:13:56.840 --> 0:14:00.720 moments of drama. You're not there to entertain. You know, 0:14:00.760 --> 0:14:04.280 they're playing. You're not playing to the audience. So yeah, 0:14:04.280 --> 0:14:07.720 it could be helpful to learn, say, um, I don't know. 0:14:07.800 --> 0:14:10.320 Would it be character acting or method acting in this one? 0:14:10.760 --> 0:14:14.520 Mm hmmm, probably method acting. So it would be useful 0:14:14.600 --> 0:14:17.720 to learn some nuts and bolts of of that, just 0:14:17.840 --> 0:14:22.640 practice and rehearse that type of acting. But you're not gonna, like, 0:14:22.720 --> 0:14:24.560 you're not gonna go get your big break or something 0:14:24.640 --> 0:14:26.720 doing this. That's not the point of it. Now. I 0:14:26.800 --> 0:14:29.920 think I would, Uh, I would try and fart a 0:14:29.920 --> 0:14:33.240 lot or something, just something very subtle. That'd be your 0:14:33.360 --> 0:14:37.120 your trademark because yeah, that would be in the in 0:14:37.240 --> 0:14:39.560 the in the lounge. Afterward they'd all be like, did 0:14:39.560 --> 0:14:43.240 you get the kind I think he was farting? Right? 0:14:43.600 --> 0:14:47.200 Was that on purpose? Or that'd be your standardized patient card. 0:14:47.720 --> 0:14:51.200 It's say, Charles W. Chuck Bryant ask about my trademark 0:14:51.560 --> 0:14:54.880 arts on command? Uh, all right, that was dumb. So 0:14:54.920 --> 0:14:56.840 we should take a break. Yeah, so I can get 0:14:56.840 --> 0:15:21.480 it together. Okay, So Chuck, let's get down into the 0:15:21.560 --> 0:15:23.720 nuts and bolts. So the nitty gritty a little bit, right. 0:15:23.760 --> 0:15:26.880 So I said earlier that all of this kind of 0:15:26.920 --> 0:15:31.640 falls under the umbrella of a standardized or a simulated 0:15:31.680 --> 0:15:36.320 patient um and then underneath that umbrella, which we've kind 0:15:36.320 --> 0:15:39.320 of been using interchangeably, but really shouldn't UM. Is the 0:15:39.400 --> 0:15:43.280 standardized patient is largely what we're talking about, and I 0:15:43.360 --> 0:15:48.440 think synonymous with the standardized patient and is the programmed patient. 0:15:48.520 --> 0:15:52.600 That first UM the first term that George Barrow used 0:15:52.640 --> 0:15:55.480 for right. And the reason that it's called standardized or 0:15:55.520 --> 0:15:58.240 programmed is because it's like you said, there isn't a script, 0:15:58.280 --> 0:16:00.480 like you don't memorize the script of the doctor says 0:16:00.560 --> 0:16:03.120 this and then you say that, but you do have 0:16:03.200 --> 0:16:07.360 like a You are given a specific set of criteria 0:16:07.400 --> 0:16:10.000 and it can be really detailed as well, and you're 0:16:10.040 --> 0:16:14.120 expected to stick to that role, that character. You take 0:16:14.160 --> 0:16:17.080 on a character, and your character is sick, your character 0:16:17.120 --> 0:16:20.800 as a backstory, there's um certain things that your character 0:16:20.920 --> 0:16:24.320 is capable of doing and incapable of doing because of 0:16:24.360 --> 0:16:28.960 the medical condition, maybe because of a prior medical history. UM. 0:16:29.440 --> 0:16:33.480 And then you go in there and you remain in 0:16:33.520 --> 0:16:37.960 this character and you do it virtually the same way 0:16:37.960 --> 0:16:41.520 as close to the same as possible for student doctor 0:16:41.560 --> 0:16:45.320 after student doctor actor student doctor usually up to about 0:16:45.400 --> 0:16:49.200 ten in a day, and they each student doctor is 0:16:49.200 --> 0:16:51.920 supposed to get the same experience from you. And the 0:16:52.000 --> 0:16:54.640 reason why they wanted that standard is because they're being 0:16:54.720 --> 0:16:57.560 graded on this, they're being tested on this. It's it's 0:16:57.880 --> 0:17:02.000 um the closest thing to sign a typically reproducible that's 0:17:02.080 --> 0:17:05.920 something as objective as bedside manner could be made into. 0:17:06.200 --> 0:17:09.880 That's the point of standardized patients specifically. Yeah, and you've 0:17:10.000 --> 0:17:13.040 um the case that you've gotten. It's either uh, something 0:17:13.720 --> 0:17:16.600 that's just made up, like hey, we need somebody that 0:17:16.680 --> 0:17:20.280 has an uh maybe a rupture dependix or whatever. That's 0:17:20.320 --> 0:17:23.280 kind of a run run of the meal, uh meal, 0:17:23.720 --> 0:17:28.520 run of the breakfast, run of the mill situation. But 0:17:28.760 --> 0:17:33.240 sometimes it's an actual case, like a real case UM 0:17:33.320 --> 0:17:37.040 that they base it on, Like someone has actually experienced this, 0:17:37.160 --> 0:17:40.119 it's been recorded, and they have this case study and 0:17:40.160 --> 0:17:43.479 they want the doctor to go through this very specific thing, uh, 0:17:43.520 --> 0:17:45.960 and in that case they want to really replicate that 0:17:46.680 --> 0:17:51.240 right down to like the age, gender, and ethnicity of 0:17:51.280 --> 0:17:54.240 that actual patient that had that actual case to begin with, 0:17:54.640 --> 0:17:57.239 right exactly. I think George Barrow, the guy who came 0:17:57.320 --> 0:17:59.919 up with us in the sixties, he based his first 0:18:00.359 --> 0:18:03.719 UM standardized patient on an actual case that he handled 0:18:03.760 --> 0:18:07.240 because he knew exactly how it presented, UM, exactly what 0:18:07.320 --> 0:18:10.119 the medical history was so and it was something that 0:18:10.160 --> 0:18:14.760 he felt could be reproduced pretty easily again and again. UM. 0:18:14.800 --> 0:18:18.600 And there's this really interesting essay that was running The Believer, 0:18:18.760 --> 0:18:21.440 but I think it made it into a collection UM 0:18:21.520 --> 0:18:25.600 in the Writer's book by a writer named Leslie Jamison, 0:18:26.320 --> 0:18:29.000 and the name of the essay is the Empathy Exams. 0:18:29.040 --> 0:18:34.640 It's about her UM experience as a standardized patient. It's 0:18:34.800 --> 0:18:39.399 really really interesting just how she's really investigating the character 0:18:39.520 --> 0:18:43.040 that she's given. Like, I think her her main characters 0:18:43.040 --> 0:18:46.080 Scott more than one UM, but her main winner, the 0:18:46.080 --> 0:18:49.040 one that she seems most attached to, her brother like 0:18:49.320 --> 0:18:53.199 drowned in after tailgating at a football game and then 0:18:53.240 --> 0:18:57.160 jumping into a river and he drowned years back, and Um, 0:18:57.280 --> 0:19:01.440 she's like still green being over the loss of her 0:19:01.480 --> 0:19:06.919 brother and it's led to seizures, but she doesn't even 0:19:07.040 --> 0:19:10.800 she the character doesn't know that these seizures are basically 0:19:10.880 --> 0:19:14.119 coming out of grief. So it's for the doctors to 0:19:14.200 --> 0:19:17.000 suss out. And that's just one of at least a 0:19:17.040 --> 0:19:20.760 couple um it's standardized patients that she's played. But it's 0:19:20.840 --> 0:19:23.800 really interesting. It's a great, great essay. Well, yeah, in 0:19:23.800 --> 0:19:26.760 them in this article that you dug up. It said 0:19:26.760 --> 0:19:28.399 that one of the there are a lot of reasons 0:19:28.440 --> 0:19:30.160 someone might want to do this, but one of them 0:19:30.840 --> 0:19:33.080 can certainly be that they had like a family member 0:19:33.600 --> 0:19:37.280 that died of a certain disease or maybe was misdiagnosed 0:19:37.280 --> 0:19:40.320 st even so they feel like this is like something 0:19:40.359 --> 0:19:42.919 they can do to kind of help out, uh that 0:19:43.000 --> 0:19:45.840 kind of research or whatever, you know, right, I ran 0:19:45.880 --> 0:19:49.680 across though, that one of the pitfalls of UM standardized 0:19:49.720 --> 0:19:52.760 patients is that the people who do it, they can 0:19:52.800 --> 0:19:55.480 have a hidden agenda sometimes and it may be as 0:19:55.520 --> 0:19:58.560 benign as yet, my brother was misdiagnosed, and I want 0:19:58.560 --> 0:20:02.679 to make sure that doesn't happen to anybody else or UM, 0:20:02.720 --> 0:20:05.600 it can be some I ran across in this comment 0:20:05.680 --> 0:20:10.159 section on a biomedical blog about some doctors, said that 0:20:10.200 --> 0:20:12.959 while he was in training, he came across a standardized 0:20:12.960 --> 0:20:15.879 patient who was sure to list all of the herbal 0:20:15.920 --> 0:20:18.960 medications that she was taking right then and then she 0:20:19.080 --> 0:20:21.160 later said that it was because she wanted to make 0:20:21.160 --> 0:20:24.920 sure that these medical students were made aware of alternative 0:20:24.960 --> 0:20:28.000 medicine as well, So she had like a specific hidden 0:20:28.040 --> 0:20:31.400 agenda that she wanted to get across to these med 0:20:31.480 --> 0:20:34.280 students without going to the trouble of going to med 0:20:34.320 --> 0:20:37.520 school herself and becoming a doctor teacher. We just kind 0:20:37.560 --> 0:20:41.199 of came in under the radar basically, and apparently they 0:20:41.200 --> 0:20:43.199 try to root people like that out because it's not 0:20:43.280 --> 0:20:45.199 the point of the whole thing. But it's kind of 0:20:45.200 --> 0:20:49.719 funny how they slipped in there. Sometimes. Yeah, and you know, 0:20:50.720 --> 0:20:53.639 you're in character unless you're doing and we'll talk about 0:20:53.680 --> 0:20:56.560 this later, but that one thing that you found and 0:20:56.600 --> 0:20:58.320 sent me is that seemed like a little bit of 0:20:58.359 --> 0:21:01.080 a different process where they might have a really specific 0:21:01.119 --> 0:21:05.399 goal in mind where you kind of do almost like 0:21:05.400 --> 0:21:10.600 play acting back and forth with the student doctor. But generally, uh, 0:21:10.760 --> 0:21:12.960 they're trying to diagnose you. So you walk in the 0:21:13.040 --> 0:21:17.000 room and you're in character. So if you've got kidney 0:21:17.000 --> 0:21:20.760 pain or bad back or a limp or whatever, then 0:21:21.119 --> 0:21:22.760 you don't walk in and say all right, let's get 0:21:22.800 --> 0:21:25.840 started and then go oh like they try to make 0:21:25.880 --> 0:21:27.560 it as real as possible. You walk in there in 0:21:27.680 --> 0:21:31.560 character with you know, holding your side or or whatever 0:21:31.560 --> 0:21:35.359 your ailment is. You don't you know, run your face 0:21:35.440 --> 0:21:38.920 over your hand over your face over smiling, like frowning 0:21:39.240 --> 0:21:41.639 to get in character. No, you don't do that. No, 0:21:41.920 --> 0:21:45.679 And apparently I've seen that if standardized patients really good, 0:21:46.000 --> 0:21:49.119 they'll be basically indistinguishable from some of the patients that 0:21:49.200 --> 0:21:54.200 the the doctor will eventually run into and their clinical practice. Right, Yeah, 0:21:54.240 --> 0:21:56.240 I mean it's it's tough, man, because you have to 0:21:57.320 --> 0:21:59.000 I mean, if you're not an actor, you might be 0:22:00.040 --> 0:22:01.639 have a talent you didn't know you had if you're 0:22:01.680 --> 0:22:05.640 good at this, because you have to memorize and internalize 0:22:06.119 --> 0:22:10.239 and study all this stuff, because you have to be 0:22:10.320 --> 0:22:13.199 just as real as someone who is experiencing something, and 0:22:13.280 --> 0:22:17.600 like that's that's the best. Like you, you would be 0:22:17.640 --> 0:22:20.919 the best actor if you literally become that person that 0:22:20.960 --> 0:22:22.480 you're playing. And that's kind of what you have to 0:22:22.520 --> 0:22:25.800 do for this, right you know what I'm saying, Like 0:22:25.840 --> 0:22:27.600 these people, if they are an actors, they might want 0:22:27.600 --> 0:22:31.160 to look into it, sure if they're good at it. Yeah, 0:22:31.200 --> 0:22:34.000 So let's talk about that. So acting is not being 0:22:34.040 --> 0:22:37.359 an actor is not a prerequisite for this, right, Um. 0:22:37.440 --> 0:22:39.320 But you could be an actor and be good at it. 0:22:39.359 --> 0:22:41.719 You could be an actor and become very quickly frustrated 0:22:41.760 --> 0:22:44.199 by the whole thing because it's not acting necessarily it's 0:22:44.359 --> 0:22:48.120 very specific type of acting, right, it's literally medical acting. 0:22:48.680 --> 0:22:52.560 But just that's not enough. You need to apparently be 0:22:53.480 --> 0:22:58.000 ceaselessly upbeat, endlessly upbeat. And the reason why is because 0:22:58.480 --> 0:23:01.639 you're going through this thing, say up to ten times 0:23:01.640 --> 0:23:04.120 in a row. And these things last, from what I saw, 0:23:04.119 --> 0:23:07.760 about forty five minutes. So you're doing this for forty 0:23:07.800 --> 0:23:10.520 five minutes, half an hour or two an hour in 0:23:10.560 --> 0:23:14.560 the in the waiting room beforehand exactly filling out forms. Yeah, 0:23:14.560 --> 0:23:16.320 because you gotta get angry before you go in there. 0:23:16.560 --> 0:23:18.840 Some guys like coughing along up next to you and 0:23:18.840 --> 0:23:22.840 it's like, oh, I'm no continued, just um. It drives 0:23:22.880 --> 0:23:24.879 me crazy when people are like, I'm not contagious. It's 0:23:24.920 --> 0:23:27.040