Simulated patient: My job is to pretend to be sick
Recently, we were told that skillful communication with the patient no less important in the work of a doctor than knowledge of the specialty. One of the most effective methods for teaching communication is training with the participation of simulated patients, that is, actors playing the role of people who see a doctor. We talked with Julia Kaul, the simulated patient of the school of professional medical communication skills “Communication”, about her work, emotional immersion in the role and her own visits to specialists.
I graduated from Moscow State University, worked as a proofreader in the newspaper Kommersant, and then as a make-up artist at the cinema, then children appeared and I devoted myself to domestic affairs for a long time. When the children grew up and I wondered what to do, I was lucky: I saw on Anna Sonkina-Dorman's post on Facebook that she was recruiting a team to work as simulated patients in the doctors' communication school. I remember how I just trembled with joy, after reading this post - as far as it suited me and it was interesting. Anna still believes that it was some incredible adventure - to look for people in this way. And for me it was an incredible success.
About eighty people responded, but after the selection the group shrank to fifteen. At the invitation of Anna from Cambridge came Beverly Dean, an actress and simulated patient with great experience - she has been doing this for almost twenty years. Dean held a casting and taught us for two days. It was a very intensive course - in the end, four people left; it was four and a half years ago, and our staff hasn’t changed since. And, of course, we ourselves continue to learn and improve our profession, we even took acting lessons.
I really like the possibility of acting - we have a lot of different scenarios. At first, we used the Cambridge base of developments: once a week we gathered and rehearsed, polished our skills. Later, however, it turned out that not all British scenarios are applicable to Russian realities, so we began to invent new situations and deal with the cases that the doctors themselves brought to classes. Constant creativity is very interesting.
Since our task is to help doctors cope with difficult situations at work, the trainings are lively, not according to a template, including at the request of doctors. At first, it was the hardest for me to request an angry patient. I myself am a non-conflict person, it is difficult for me to quickly gain a tense emotional level and to keep it - this is not typical of me. It all depends on temperament: for example, our colleague has a conflicted patient best of all - it seems that he is ready to throw chairs or beat dishes. But time passed, experience appeared, and now such a role is easier for me.
At first, it was the hardest for me to request an angry patient. It all depends on temperament: for example, our colleague has a conflict patient who is best at work - it seems that he is ready to throw chairs or beat dishes
Another difficulty of the work is that you need to do several things at the same time: to be in a role, to remember the words of the doctor and at the same second to reflex, tracking your own feelings and reactions. Then it will be needed to give feedback. Actually, feedback is the most valuable in the method of working with a simulated patient, because in normal practice the doctor will never receive it in this form. The specialist does not know why the patient did not return - because he was cured or because he was offended?
Doctors share with us anxiety, they say that after talking with patients, they often have a feeling of understatement. And at the training you can learn about the feelings and emotions of a person, we give feedback in a simple and understandable manner: "When you said ... I felt ..." Ultimately, the quality of communication also determines the quality of medical care: full communication helps to ask the patient get the right information, much to clarify, to ensure that the person understands the importance of treatment or limitations. Effectively speaking with patients is difficult; experience is needed for this, but there are methods and techniques that help get on the right path.
The training itself takes place in different ways: sometimes a long-lasting situation is played out, sometimes - little things for deep study. There are simple scenarios that you can use for additional details and circumstances. The coach stops the game when he sees that there is enough material for conversation. Then everything is discussed and replayed - with the new knowledge of the doctor, so that he can do otherwise. This is also very valuable - in real life it is not possible to “wind off” the situation back and begin a conversation with the patient again, and with the same words. And here we can safely do it again and again. Surprisingly, with the same start of the dialogue, the patient's behavior and the outcome of the situation change literally from one skill or specific words of the doctor.
Emotional immersion in a role is different, and first of all it depends on the task set by the doctor. I carefully listen to the request and twist the level of the game to create a suitable learning situation. If the doctor says that it is difficult for him to work with silent patients, of whom you need to carry information with ticks, then I understand that I must be restrained. If the doctor is afraid of emotional reactions (for example, to a diagnosis message) and tears, then I have to give him exactly that.
This is a very energy-intensive work - and not because I am burdened by experienced emotions. They do not catch up with me during the day and do not make me worry, but after several bursts in a day I get very tired. In addition, I mentally return to the day I spent, think about my game, analyze stories for myself, how everything went. Be sure to recover, and for this everyone has different ways. I have two of them: either I just go to bed, or we go to a cafe with Anna or somewhere else and laugh a lot. We have a task: to spend a good fun evening after the working day. And we also give homework to the doctors - to indulge yourself and relax, let it be a good movie, a glass of wine, delicious food or a hot bath.
Of course, when I go to the doctor myself, I notice shortcomings in communication. True, now that I am familiar with so many good specialists, I can choose - and try to consult with those whom I saw at the trainings. At the same time, I really do not want the doctors to perceive my appeal to them as a check or "test purchase." In principle, I used to pay attention to the fact that one doctor has to himself, and the other does not want to tell anything - he will make a diagnosis and that's all.
Now I collect stories that can be used in my work - I take notes on everything that people tell about doctors, diseases and communication, this is my professional interest. Now we often work in the most interesting format for specialists - on request, when they themselves bring in complex cases (for example, how to tell the patient bad news). This is a very high level: you need to instantly invent a living person, know the circumstances of his life and understand why he behaves this way. Some of these stories are not close to me - and I need to find a similar situation in my memory and understand why a person can react this way.
If the doctor says that it is difficult for him to work with silent patients, of whom you need to carry information with ticks, then I understand that I must be restrained. If the doctor is afraid of emotional reactions and tears, then I have to give him exactly that
The training day is a full eight-hour working day with a lunch break. I am constantly present - it is interesting for me to meet with doctors, to listen to what kind of people they are, what experience they have, to understand their needs and desires. We used to alternate during the day, but now we realized that one simulated patient is enough for all scenarios. It is extremely rare to need a man or a woman — for example, if a situation like breast cancer is discussed at the same time as planning a pregnancy. But in most cases the situation applies to everyone.
The skills we teach are also universal, they are suitable for any specialty. We deal with a variety of doctors: dentists, transplantologists, pediatricians, general practitioners, resuscitators. I know that in other countries, veterinarians often come to such courses because they need to be able to communicate with the owners of animals. In this regard, they can be compared with pediatricians: when working with young children, the doctor builds a conversation primarily with the parents, and not with the patient himself.
Now, when the Ministry of Health has called for teaching all medical students ethical communication with patients, there is a risk that this will be done poorly - especially since neither time nor money has been allocated for it. In medical higher education institutions, it may be decided that any student will cope with the role of a simulated patient, but this is not so, this is serious work that requires special training. But if the approach is correct, then, of course, the training of doctors will reach a new level.
Photo:Amazon (1, 2)