Image by Mohamed Hassan from Pixabay
For those who do not know an SP is a standardized patient. We are used to help train medical professionals like med students, pharmacy, nursing etc. We are basically actors role playing medical appointment scenarios.
We are in fact standardized. We have the same names, date of birth physical symptoms etc. We each had several cases and they had a very specific formula. One of the hardest aspects for me was me NOT going into detail and just answering the questions that were asked.
SP is a tough but fun job. I worked mostly with osteopath students but also worked with PAs and pharmacy students. A part of our job was acting, the other part was evaluating students both on what they investigated (did they ask the appropriate questions? Do a thorough physical exam etc)and also their bedside manner, professional appearance etc. We also gave feedback to the students about the encounters. Feedback was a huge part of the job. Also group feedback was usually hilarious.
Since I was at a school for osteopaths the student expressing empathy was a requirement and the students would fail if they did not do this even if they got everything else right. Not only would they not be allowed to take their boards but they also could fail the boards for not expressing empathy. Oh boy do I have stories about working with those students. They were....difficult.
It's a lot of work. Not only do we need to memorize our characters date of birth personal and family medical history social aspects such as substance use, sexual activity/orientation. marital status , kids etc and be able to fake physical exams/know what is supposed to hurt(or when to cough) when we also need to evaluate the student's performance and have a checklist . All while being in character. It's a lot. Too much really. I personally think the technical evaluations should be done by another SP through the videos and sometimes it is to check our work or learn how to play the role. Also these technical evaluations are also done by faculty who are all drs and they have a much broader checklist than SPs do.
Fun fact: Not all Sps are actors. Our school specifically hired non actors as well as actors to represent how different patients present in medical settings. It was an even split really. I was an actor and I would often get special additional assignments like during lectures or special events .
One time my performance was so convincing my supervisor was legit uncomfortable and wanted to give me a hug. :). This was an especially tough case and I can write about it if anyone is interested.I also did some of the fx make up like bruises and cuts.
I would also work with students who needed ADA accommodations. These encounters were separate(but the same exact cases) because these students got more time and since everything is on a schedule they could not be done at the same time a 14 minute encounters were done if they needed 25 minutes.
I miss this job so much but my chronic illnesses got too severe and I can no longer do it.
Our work day was spent in hospital gowns though we were allowed to wear shorts and sports bras. There are specialty SPs that do things like real gynecological exams but we did not do that at our school. There was another med school not too far away that did that. Many Sps worked at both locations even though the schools were not affiliated. Though occasionally the PAs from the other school would come to us and use our facility.
Since we SPs monitor each other (watching live or pre recorded videos) it was not uncommon to see our co workers in their bras. Male Sps would look at encounters with female SPs and for the most part no one had any issues. Sps were protected by HIPPA as sometimes in history and physical scenarios we would use our own health histories in these encounters. That too was standardized. If I told one student I had asthma, I told every student.
There was one creepy SP but that is a whole other scenario.
Heart and lung exams on female patients were the funniest encounters to me. Imagine this scenario. There is a faculty dr in the room watching as well as other faculty members and SPs monitoring the cameras.
I swear they put the largest breasted women on these cases on purpose. This is something we would joke about but it's true. We called it the "big boobie club" amongst ourselves.
Usually these encounters were with 2nd year med students and the male students struggled with this the most . There are times where a patients' breast needed to be moved to listen to heart/lungs etc and this was awkward for the students. The female Sps were briefed about this happening and were allowed to opt out of these cases if we were uncomfortable.I gave zero fucks .As a theater kid I was used to being in various states of undress in front of men women, gay, straight etc and I really didn't care.
The students are supposed to drape the SP and make sure they are asking for consent before touching and respecting the SPs modesty. Sometimes that would fail. I had many an encounter where the student did not drape or didn't tie my gown back up and I was basically talking to them in just my sports bra. I was ok with this(but still marked it on my checklist) but if another SP wasn't this is one of the times they could invoke "real life' (a safe word) and /or dress themselves. The student would be dinged on this but the comfort of the SP is important.
There also usually was a faculty member in the room and sometimes they would speak up. I got to know them and they pretty much knew that I in fact gave zero fucks about it as long as the student made a mistake and wasn't being creepy.
Yes that has happened. I have had students hitting on me in these encounters. These students didn't graduate.
That job was fun.The faculty doctors treated us as equals. We called them by their first names (their request) and not Dr. Smith or whatever, We would often have fun in the break room chatting like colleagues.
I wish drs in real life were this respectful of patients.
I had my Reynauds diagnosed by a faculty doctor. Reynauds is a vascular condition (though evidence of autoimmunity is present)where the extremities over react to cold or in some cases physical or emotional stress. Mine is exclusively temperature triggered. Cold for me is anything 70 degrees or under, My fingers turn pale white and go numb. When blood returns they go red and it hurts a lot This was normalized my wile life, I get frostbite -like symptoms in 70 degrees. This is not normal. I also have dysautonomia and can't regulate my body temperature and I think this is partially why I am so temp sensitive.
One morning a faculty doc was in the room when I was making coffee.3 of my fingers were numb and pale white and I dropped a coffee cup. The doc noticed and said "How long have you had Reynauds?' I had no idea what he was talking about. He explained it, then said I should take a picture and show my primary care doc because that is classic Reynauds. It was 65 degrees out and that was abnormal.
side note for medical professionals Reynauds is often seen as benign however I do not know a single person with Reynauds that doesn't also have an autoimmune, vascular, neurological or autonomic disorder or a combo of these. Every single person I know has at least one of these conditions. My personal opinion there is no "primary Reynauds at least not the way it is shown in medical literature as a benign condition. There is ample evidence now that it may in fact be it's own autoimmune condition at least in some cases. This distinction matters. just undiagnosed autoimmunity etc. I am in contact with hundred of chronic illness patients who mostly say Reynauds was one of the if not the first sign something was off.
Also medical professionals If your patient had mottling /cyanosis please do not just say they are cold. This can CAUSE the limbs to be cold and is a serious sign of vascular and/or neurological/autonomic issue. It is not normal. Quick test -if patient is sitting upright have them lay down. it if resolves in a few minutes of patient being supine something is seriously wrong.
Anyway, that's the basics of SP life.A fun , rewarding job that usually pays pretty well. Its not for everyone but a good SP can influence a med student and ripple effect help the care of thousands of patients throughout that drs lifetime.
@thebighigg @freecompliments I thought you guys may like this
A very interesting read from your perspective! Thank you so much for sharing. It sounds like a job that you genuinely enjoyed and that you took interest in the education of students. Even though medical students are bundles of nerves when working with SPs, we can tell when they truly care and enjoy the job - and most do.
There was one SP who helped me - on his own time - with some extra practice due to an impediment I had (I refused yo use extra time accommodations that were offered to me, and instead chose to practice more so I could finish within regular time limits). I should find a way to reach out to him and thank him again, since it's now been several years since I've last seen him. It's a great memory of someone who went out of their way to help. I believe he saw that I also cared to improve myself, which may have factored into his choice to help me.
Good tip with the Raynaud's - it's well-known to be associated with autoimmune conditions, although I'm not experienced enough with its prevalence to differentiate primary vs. secondary. Noteworthy enough to keep a close eye for further symptom development, however. I'm going to stick that one into the memory bank.
I love this story so much. I wish I could somehow work as a virtual /webcam SP. I would even volunteer to do it if it were a thing. ❤️🦄
Reynauds-there is a test using a microscope that can detect if there is vascular damage. I can't get anyone to run the test even vascular specialists. Like FFS just give me a microscope with a camera and some nail oil and I'll do it myself. In general primary reynauds is reynauds without an underlying condition .Drs in general don't test for underlying conditions and I have yet to meet a person with reynauds, even in exclusive reynauds groups who do not have an underlying condition. Most say the condition was dx years in some cases decades after(..
There is also new evidence Reynauds is a separate autoimmune condition itself....
I am not sure how it's taught in schools but drs seem to think Reynuads tends to happen after another dx like MS or something, or is a stand alone condition. In reality it's usually the first sign BEFORE the patient is diagnosed or even before the patient has many if any neuro/inflammatory sx. With most Reynauds patients being female and female patients less likely to even get the testing for other diseases(because drs do not believe us in general) it's kinda a clusterfuck.
And FFS stop saying (general not you personally lol )mottling and/or cyanosis is because women are cold in the middle of a heat wave in the summer. Yes my limbs are cold but that's because my blood is not flowing not because I am cold. I have never had this trigger being cold, only orthostatic stress.
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