Do you prefer one role over the other?
In some ways, I really preferred doing the GTA work because I was empowered in a different way. The impact I made was clear and immediate. There’s no script. I got to say, “Hey, instead of calling this table a bed, let's call it a table, and this is a drape, not a sheet, and let's pull the back of the table up so I can make eye contact with you during my exam.” The feedback is very direct, whereas standardized patients work within a script and specific guidelines. I enjoy both, and they are very different roles.
You’ve been a standardized patient, an actual patient, a GTA. What do you think is the most important part of the patient doctor relationship?
I always tell students, “When you first meet a patient say some equivalent of this: ‘I am your partner in your healthcare. My job here today is to find out what's happening so that I/we can take care of you.’” If they say something like that, they change the dynamic drastically. Students are always trying to figure out, How do you build rapport? That's it. That’s all you have to say.
Because what's common is that a patient goes into their doctor's appointment, and the white coat shows up, and then the patient is instantly disempowered. They may forget why they came or default to whatever the doctor says. They might even leave without having their issues addressed. For me, saying the above statement levels the playing field.
How does your work affect you as a patient in the real world?
Because of all my work as a GTA and SP I’m probably the most empowered patient you’ll ever see. I only choose practitioners I feel I can partner with. I always tell my practitioners my background. I used to have a nurse practitioner when I was living in Oakland who knew what I did, so during each appointment she would say, “What new techniques do you have to share with me?” She was interested, and that made me feel good. That is partnership. If it doesn't feel like I can partner up with my practitioners, then I'll choose someone else.
Can you give an example of something you’ve experienced in your position and how you gave feedback?
When I was working at the University of Michigan, I was asked to go see a resident at a local clinic because patients were coming to the clinic and if they saw this practitioner once, they never came back. I was asked me to go and see what was what going on.
From the moment the resident entered the room it was clear to me what the issue was. Sometimes when people concentrate, they get weird looks on their faces. Some even stick their tongues out. As a doctor, it’s imperative to take responsibility for that kind of thing. This resident had a look of disgust the entire time he performed the exam, which was off-putting. As a patient, if someone's performing a breast and pelvic exam and they have a look of disgust on their face, you wonder, What's wrong with me? Why aren’t they saying anything?
So with things like that, when you’re coaching, you can share with someone, “Hey, it's fine if when you concentrate, you stick your tongue out, or you make funny faces, but just let the patient know up front. Tell them, ‘I've been told that I often have odd expressions on my face when I concentrate, so I wanted you to know so you won’t be surprised.’” Saying something like that takes the awkwardness away. It’s not to make the practitioner or the student feel anxious, because they’re probably already feeling that way. It's more like a reminder for them: Just remember you're dealing with another human being. It's those kinds of things that I believe make a difference for future doctors and for future patients. I always want to instill that in the practitioners I work with.
Are there any other memorable moments or experiences that jump out at you that you'd like to share?
Here’s one from the negative side. I worked with a medical student years ago at Stanford. I was training this student on how to perform a breast and pelvic exam, and we were debriefing. And he was not interested in anything I shared with him. He said something like, “I'm not going into OB-GYN, I'm going into psychiatry, so this doesn't matter.” And I just thought, I need to red flag this person, because really, how is a psych patient going to connect with you if you're being so arrogant?
Luckily that has been rare. Most of the students are so excited to practice and they're nervous. They really want to create a safe environment. They hang on every word. So when you have someone who doesn’t, it's invalidating. That experience was quite upsetting to me. I knew that I had valuable feedback for this student that will make a difference in his world, and he seemed not to care.
And what about some positive experiences?
I grew up in Ann Arbor. So, while I lived there, I saw some of my students come through as doctors. When my sister gave birth to my nephew, one of the students I’d worked with was in the room, and the same thing happened with the birth of my goddaughter. It was sweet knowing that I originally taught them when they were in their second or third year of medical school and then years later getting to see them in action as practicing doctors. I could tell by their mannerisms that they had gone through a powerful breast and pelvic exam training program, because their bedside manners were caring and thoughtful.
Often at Stanford when I’m working as a standardized patient, I frequently see students I worked with as a GTA or earlier in their school training and it makes me smile. It's wonderful to see the growth and changes in the students. Seeing them move from the awkward, How do I use a stethoscope? Where's your pulse? stage to the stage where they start asking questions professionally is so great. It’s also great to notice their physical changes, the increase in their comfort level and confidence. I love being a part of their learning and continue to be inspired by the whole process.