How Standardized Patients Work

time off to recover after that two day grind. We're eating Vancouver the Vogue Theater September twenty six, followed by Minneapolis. We're gonna be at the Pantageous Theater again on September that is correct, yep. And then Austin Chuck on October tenth of the Paramount Theater, Yes, and very special show and Lawrence Kansas at Liberty Hall on October eleven, yep. And then we're gonna do a three night stand October two at the Bellhouse in Brooklyn, New York. And then Chuck,

take it home. Uh, well take it home literally, because we are finishing up November four right here in Atlanta at the Bucket Theater and this is a very special benefit show. Uh, and all the Proceeds will be going to Lifeline Animal Project of Atlanta and the National Down Syndrome Society YEP. And for more information in DWO buy tickets, just go to s Y s K live dot com. Welcome to stuff you should know. I'm from House Stuff

Works dot com. Hey, welcome to the podcast. Blame is Josh Clark, and I'm proud to introduce my partner co hosting Crime, one of those two Mr Charles W. Chuck Wayne Chuck Tran Bryant Chuck Tran yep. And this week, Chuck, we have a very special guest producer filling out the seats. Right is the rump of Noel around. Yeah, Jerry's she's at the beach because she needs a vacation. I'm good, guys. Yeah, Jerry's romping at the beach with her wife and her daughter and a bunch of friends. And you know, I

think that sounds lovely. Well, yeah, the beach rocks. Even Miley Cyrus likes the beach. Now, I don't get it. She's got this new single out about how her boyfriend introduced her to the beach. Is pretty sweet song. Actually, you know this stuff? I just I my my wife produces me to think sometimes each otherwise would never ever have come across like, I can pick on you for that, but I would never pick on you me for that. You know, what, are you a monster? You know? Pick

on a man's wife? Right? So, yeah, it is a cute, cute, sweet song. Though I can I can give it a hearty endorsement. Emily has her little secrets to from even me. She's she singing this song the other day that was on some TV show. I was like, how do you know this? I've never heard the song, and she said, no, you know it's a song. I know what song. I don't even know what it was. It was just some kind of bubblegum poppy thing you don't and that's kind

of not her. But you never you never know, you know, I might have a fromer boyfriend, s Todd Todd Hodds into bubblegum pop. He's a jerk, he's got frosted tips on his hair, he's got a severe embre. So which one are we doing? We're gonna do standardized patients and um, it's funny. The the thought occurred to me to go through this entire episode without mentioning sein felt at all, just to make people really angry. Man. We would have

gotten so many emails though. But that's kind of like you can't not mention the very famous Seinfeld episode where Kramer and uh, who's the other guy, Mickey? Oh? Yeah, I forgot Mickey was one too. Was that his name? Yeah, it's his friend who was a little person. Yeah, and they they were. I think Mickey got him into it, and they were they were And I didn't even know they were called standardized patients. I doubt if they said that on the episode. I don't remember what they called them.

They surely they call them something. Well, they have a few names, simulated patients, standardized patients, care actors. Well, there, those are. Some of those are different. They're they're generally the under the umbrella of say like a simulized or stand simulated patient, but they're slightly there's little nuances there that that make the whole thing revolting, lee fascinating. Programmed

patients and that what the first guy called it. Yeah. Man, if that's not like a brain doctor's name for it, then I don't know what. Uh, well, should we start there. Yeah, let's go back to that guy, a doctor named Howard Barrow. He worked out at USC Ego Trojans and he was teaching back in the early sixties, late fifties, I believe, and apparently at the time, Chuck, they would just teach you everything and then say, okay, you've graduated, your going

goodbye to practice medicine. Good luck with a live human exactly, you've never encountered one throughout your entire training, but you're a doctor now, so we we wash our hands of you. Right. And so this guy was teaching neurology and realized, like I think he had a friend who had come to to start like observing his graduates in a clinical setting, but like after they graduated and we're practicing doctors and we were like whoa, well, whoa, you guys are doing

this all wrong. Who taught you this? And like you did? And uh, He's like, all right, well, we gotta do something different. So that doctor figured out that he could sit down and go through basically observe a doctor doing an entire patient history and exam and everything. But each one took like two to three hours, and they're like, there's gotta be a better way to do this. So Barrows was it was his idea, and his idea alone.

Right from what I understand I saw, I came across another doctor, a woman pediatrician, woman named Paula's Stillman, who came up with this idea also seemingly independently in the early seventies. Um, because it didn't catch on big time in the eighties. So I think she am Barrow are kind of like the earliest practitioners of this thing. Well, it wasn't a big hit at first, Like people kind

of made fun of them, uh. I know in this one article you found they there were newspaper articles, one in the l A Herald Examiner that had a headline that said Hollywood invades USC Medical School. Uh. In in the San Francisco Chronicle, of all places, they said scantily clad models were making life a little more interesting for the USC medical students, which is really I mean, I guess it's a sign of the times, but really kind

of a crappy way too. You know, they made it sound like it was some titilating sexual thing, right, because you know, they had these people that are really doing what you know, what I learned was a super valuable service. Well, yeah, for sure, I think they were just trying to sex it up for the paper. You know what I mean, they're reading audience because they were like Zodiac Killer coming soon, what's that stay tuned? But he wasn't around yet, so

they had to do something. So they were just trying to take something that was actually, yeah, a valuable service and pretty straightforward and again sex it up a little bit, but it actually it kept it from catching on for a while, at least at first. It wasn't until I think the mid eighties that Barrow was able to like get it to start to become adopted throughout the the the medical universe and the United States at least. Yeah,

and you know what, we've done that thing again. Yeah, I know where we haven't said what it is yet. You had to have seen Seinfeld and know how to read between the lines of our conversation. Yeah. So a simulated patient or a standardized patient is um Sometimes you're

an actor. Sometimes they have no acting experience. Sometimes it we'll get to who these people are, but they're generally people looking to make a buck, who are who fit the profile and of being a fake patient to a medical student so they can get a real practical human to human experience in medical school exactly because there's a big difference between book learning in real life, right, and if you're a doctor, a huge, huge part of your UM,

your job, especially UM non surgical doctrine is conversing with a human being patient and and on the one hand, treating them as a human being, not a set of symptoms. That's a big one. But then also um, getting out of them what's wrong with them so that you can diagnose them. Yeah, that's I thought this was all sort of just about bedside manner and like being you know, because it's a big part of the job. You know,

you want a doctor. If you've ever had a doctor that had a poor bedside manner, you know what I'm talking about. UM, If you haven't, then you might take it for granted that everyone's like that, but that's not the case. But the second part of that I didn't really think about. But um. The director of the Standardized Patient Program at University of Pittsburgh School of Medicine, Valerie Former, who they don't know if they interviewed her for this or if she was just they pulled some quotes, but

I never really thought about it. She said, communication is at the root of proper diagnosis, patient safety, and patient satisfaction and miscommunication can lead to medical error, so they have to A big part of the job is drawing out of the patient what the heck is wrong with them, because they can examin until the cows come home, but they need words, right, So like, yeah, patient who comes into the doctor's officer, that e er isn't gonna be like, um,

I have an abscess on my right kid. Need that needs to be treated or else I'm gonna die of sepsis in the next twelve hours. Is my my my side hurts, That's what you get. So you have to ask more questions and know what questions to ask. So yeah, it's it's diagnosis, learning how to diagnose from talking to

people in drawing info out of them. But that bedside manner that's not to be overlooked, Like that's a big part of it because you know, if if people start to think every doctor I've ever interacted with treated me like I was just a bag of organs and bones, which we couldn't couldn't sure, and couldn't care. But you're not supposed to to let on that every like we all have to pretend in this big grand manner, right exactly, And but it will keep you from going to the doctor.

And if you stop going to the doctor, and then health problems can can start to accumulate, and it's all the doctor's fault for being a sociopathic jerk. Well yeah, but you also you know in that um which one were we talking about doctors being too empathetic? The empathy one? Oh yeah, okay, there you have it. You didn't want

to dr fell to pieces. No, you you need to learn to walk that fine line between being too clinical and too much of an EmPATH to where the patient feels eddies and taking care of but you feel confident and they're not like breaking down and crying because they

have to tell you that you may be dying. Let's say. Yeah, but the the lady from the University of Pittsburgh who was interviewed in this article points out that there was she she remembered at least one medical student who did break down because of an interaction with a simulated patient

or standardized patient. UM and that that that that's the point of a similizer or simulated or standardized patient is so that you can go ahead and break down like that and get it out UM In in a basically a classroom setting, so that when you encounter this in the real world, you'll have already gone through that. Yeah, and um, we'll get into the nuts and bolts of it in a bit. But um, if you're wondering if you want to go do this, if you have to,

like you know, get a prostate exam. Um, you don't have to, but if you're if you're open to that kind of your intention, you can sign up for a more intense uh and I imagine those are the ones that pay a little bit better. But you can go in and volunteer for a prostate exam or or or breast exam or anything that involves something a little more uh um invasive. Yeah, but you're not gonna get cut or you're not gonna get a needled or anything like that.

They're not going to practice that kind of stuff on you. Right. I was reading the f a Q on the University of Pittsburgh site about their um simulated patients, and they point out that patients simulated patients will not be given drugs. Yeah, then that can inject you with like a cocktail of antipsychotics and stimulation, and this may be a good way to score, right, But it's on you, is the simulated patient to um to act as if you're um going

through a psychotic break right there. Yeah, potentially so that the doctor can learn how to deal with that kind of thing. That's probably one of the more dramatic examples. I think a lot of them are a lot more pedestrian, but that is definitely in the mix as well. Well. Even though you're as we'll see, it's you sort of, Um,

it's not scripted. You do have to be an improviser of sorts, but you're supposed to stick to kind of I don't think you're supposed to throw them any just curveballs that you think of in the moment, uh, which is what I would want to do, which is probably I would not be a good sp That's what Kramer did. Yeah, he he could have made it into like a real

acting gig, right right. And they say that actors can be good at this, but it's not acting, like they point out that, Um, there's no you're not searching for moments of drama. You're not there to entertain. You know, they're playing. You're not playing to the audience. So yeah, it could be helpful to learn, say, um, I don't know. Would it be character acting or method acting in this one? Mm hmmm, probably method acting. So it would be useful to learn some nuts and bolts of of that, just

practice and rehearse that type of acting. But you're not gonna, like, you're not gonna go get your big break or something doing this. That's not the point of it. Now. I think I would, Uh, I would try and fart a lot or something, just something very subtle. That'd be your your trademark because yeah, that would be in the in the in the lounge. Afterward they'd all be like, did you get the kind I think he was farting? Right? Was that on purpose? Or that'd be your standardized patient card.

It's say, Charles W. Chuck Bryant ask about my trademark arts on command? Uh, all right, that was dumb. So we should take a break. Yeah, so I can get it together. Okay, So Chuck, let's get down into the nuts and bolts. So the nitty gritty a little bit, right. So I said earlier that all of this kind of falls under the umbrella of a standardized or a simulated patient um and then underneath that umbrella, which we've kind

of been using interchangeably, but really shouldn't UM. Is the standardized patient is largely what we're talking about, and I think synonymous with the standardized patient and is the programmed patient. That first UM the first term that George Barrow used

for right. And the reason that it's called standardized or programmed is because it's like you said, there isn't a script, like you don't memorize the script of the doctor says this and then you say that, but you do have like a You are given a specific set of criteria and it can be really detailed as well, and you're

expected to stick to that role, that character. You take on a character, and your character is sick, your character as a backstory, there's um certain things that your character is capable of doing and incapable of doing because of

the medical condition, maybe because of a prior medical history. UM. And then you go in there and you remain in this character and you do it virtually the same way as close to the same as possible for student doctor after student doctor actor student doctor usually up to about ten in a day, and they each student doctor is supposed to get the same experience from you. And the reason why they wanted that standard is because they're being

graded on this, they're being tested on this. It's it's um the closest thing to sign a typically reproducible that's something as objective as bedside manner could be made into. That's the point of standardized patients specifically. Yeah, and you've um the case that you've gotten. It's either uh, something that's just made up, like hey, we need somebody that has an uh maybe a rupture dependix or whatever. That's kind of a run run of the meal, uh meal,

run of the breakfast, run of the mill situation. But sometimes it's an actual case, like a real case UM that they base it on, Like someone has actually experienced this, it's been recorded, and they have this case study and they want the doctor to go through this very specific thing, uh, and in that case they want to really replicate that right down to like the age, gender, and ethnicity of that actual patient that had that actual case to begin with,

right exactly. I think George Barrow, the guy who came up with us in the sixties, he based his first UM standardized patient on an actual case that he handled because he knew exactly how it presented, UM, exactly what the medical history was so and it was something that

he felt could be reproduced pretty easily again and again. UM. And there's this really interesting essay that was running The Believer, but I think it made it into a collection UM in the Writer's book by a writer named Leslie Jamison, and the name of the essay is the Empathy Exams. It's about her UM experience as a standardized patient. It's really really interesting just how she's really investigating the character

that she's given. Like, I think her her main characters Scott more than one UM, but her main winner, the one that she seems most attached to, her brother like drowned in after tailgating at a football game and then jumping into a river and he drowned years back, and Um, she's like still green being over the loss of her brother and it's led to seizures, but she doesn't even she the character doesn't know that these seizures are basically coming out of grief. So it's for the doctors to

suss out. And that's just one of at least a couple um it's standardized patients that she's played. But it's really interesting. It's a great, great essay. Well, yeah, in

them in this article that you dug up. It said that one of the there are a lot of reasons someone might want to do this, but one of them can certainly be that they had like a family member that died of a certain disease or maybe was misdiagnosed st even so they feel like this is like something they can do to kind of help out, uh that kind of research or whatever, you know, right, I ran across though, that one of the pitfalls of UM standardized patients is that the people who do it, they can

have a hidden agenda sometimes and it may be as benign as yet, my brother was misdiagnosed, and I want to make sure that doesn't happen to anybody else or UM, it can be some I ran across in this comment section on a biomedical blog about some doctors, said that while he was in training, he came across a standardized patient who was sure to list all of the herbal medications that she was taking right then and then she later said that it was because she wanted to make

sure that these medical students were made aware of alternative medicine as well, So she had like a specific hidden agenda that she wanted to get across to these med students without going to the trouble of going to med school herself and becoming a doctor teacher. We just kind of came in under the radar basically, and apparently they try to root people like that out because it's not the point of the whole thing. But it's kind of

funny how they slipped in there. Sometimes. Yeah, and you know, you're in character unless you're doing and we'll talk about this later, but that one thing that you found and sent me is that seemed like a little bit of a different process where they might have a really specific goal in mind where you kind of do almost like play acting back and forth with the student doctor. But generally, uh, they're trying to diagnose you. So you walk in the

room and you're in character. So if you've got kidney pain or bad back or a limp or whatever, then you don't walk in and say all right, let's get started and then go oh like they try to make it as real as possible. You walk in there in character with you know, holding your side or or whatever your ailment is. You don't you know, run your face over your hand over your face over smiling, like frowning

to get in character. No, you don't do that. No, And apparently I've seen that if standardized patients really good, they'll be basically indistinguishable from some of the patients that

the the doctor will eventually run into and their clinical practice. Right, Yeah, I mean it's it's tough, man, because you have to I mean, if you're not an actor, you might be have a talent you didn't know you had if you're good at this, because you have to memorize and internalize and study all this stuff, because you have to be just as real as someone who is experiencing something, and like that's that's the best. Like you, you would be the best actor if you literally become that person that

you're playing. And that's kind of what you have to do for this, right you know what I'm saying, Like these people, if they are an actors, they might want to look into it, sure if they're good at it. Yeah, So let's talk about that. So acting is not being an actor is not a prerequisite for this, right, Um. But you could be an actor and be good at it.

You could be an actor and become very quickly frustrated by the whole thing because it's not acting necessarily it's very specific type of acting, right, it's literally medical acting. But just that's not enough. You need to apparently be ceaselessly upbeat, endlessly upbeat. And the reason why is because you're going through this thing, say up to ten times in a row. And these things last, from what I saw,

about forty five minutes. So you're doing this for forty five minutes, half an hour or two an hour in the in the waiting room beforehand exactly filling out forms. Yeah, because you gotta get angry before you go in there. Some guys like coughing along up next to you and it's like, oh, I'm no continued, just um. It drives me crazy when people are like, I'm not contagious. It's like you don't know, you have no idea whether you're contagious or not. Um. But so you have to do

this maybe ten times in a row. It's about forty five minutes per from what I saw, and that that tenth one needs to be as great a performance as that first one because those are two different medical students. There's ten different medical students seeing you, and each one needs to get your best because, as far as they're concerned, this is their training. They're not looking at your day, you know, like, oh, I'm one of ten. It's this is my this is my big, my big test, or

my big training. So you need to give each one you're you're you're all in that sense, you have to have a lot of energy, a lot of spunk, a lot of positivity. Um. And then you also have to be very comfortable dealing with medical professionals, which is not necessarily always the easiest bunch to deal with from what I understand. Well, no, I mean if you have a

phobia of doctors, then this is not the gig for you. Sure, And I think if you are easily crushed by pushy, um arrogant people, it might not be the best gig for you either. But doctors can beat ted arrogant sometimes. I mean we all saw Malice. I don't think I saw that. Yeah you did. When Alec Baldwin is like, do I have a God complex? I don't have a God complex. I am God. I just thought that was Alec Baldwin, like probably what you tweeted it, right? Uh, No,

I never did see that. Actually I remember the movie though, Um, yeah, it was good eighties of late eighties movie. But but yeah, So you can't just be like a wilting flower when a med student gets all mad or pushy or whatever.

And you also have to be the type who could conceivably take charge and can take control if if a med student is doing that and UM kind of maybe guide them back a little bit toward where they should be, or at the very least being willing to give them feedback to their face about how they just royally screwed this whole thing up because they're over aggressive or because they were um under assertive. Who knows you, I think you run into all of that stuff, and you have

to be prepared to do this. So that brings up another point too. You have to have a really good memory because it depending on who you ask. A lot of the um simulated patients will also be required to give feedback. Some of them, I got the impression have something to do with like the scoring or grading process as well. So you have to be in care. So you have to have your character's history, symptoms, everything memorized.

You have to stay in character. You have to um respond to the doctor's questioning, and then you have to um be paying attention to all the stuff the doctors should be asking all the stuff the doctor is failing to ask, and um, the doctor's just behavior in general, so that you can give accurate feedback afterward, and then you have to do it ten times in a row

in a day. Yeah, and this this serves a very specific need, um beyond the obvious that uh, well, there's a few things and then and they're all somewhat obvious, but it bears going over um an experience of of medical students. You don't want them practicing on a real sick person because they if they mess up, that's not good. So having almost like a live uh recessa annie on your hands is good. I had a live or says that any my mom used to bring those homes she

used to teach CPR. What would you do with them? I tried to teach and then I learned to kiss. I knew something weird went on. I tried to learn CPR here that I think I've learned it like four or five times in my life. I keep keep forgetting it. So the one thing I do remember is you want to do it to the You want to press the um. Why is it called where you do where you give

chess compressions to the beat of staying alive. And then apparently, um, you don't give breathing aid, like you don't pinch their nose and breathe into their mouth for a couple of reasons. One, you're exhaling carbon dioxide directly into their lungs, so that's stupid. And then too, they don't really have a way to expel it. So now they apparently, from what I understand, they just recommend chess compressions until um paramedics arrive. Is

that the latest accurate? I don't know. I should probably look at up before we publish this. Yeah, we should say too that we're not trained medical professionals. Now we're not even trained medical actors. And you are now taking life saving advice from a guy who learned to kiss from a lifeless Uh, synthetic. She wasn't lifeless when I was kissing. She went her little curly wigs fun on her head. Uh. All right. So the first thing is inexperience. You don't want a medical student to be messing up

on real people. UM. Number two is availability. Uh, they have to teach, they have to run the gamut of medical issues, and you just can't count on having real you know, being able to source real patients with that specific problem. So it's really easy just to teach someone to act like that. Uh. And finally, a real patient, uh isn't supposed to provide feedback constructive feedback for their doctor.

I suppose they could. Yeah, even if they could, though they're not necessarily like they're going to be like, again, my kidneys absessed them in a lot of pain, don't really care about your medical career. Just fixed me. Yeah, you can you call seen at the end of this thing. And then they go all right, now, let's like you said, let's talk about it. I'm really not in pain, so I'm fine to have this conversation. Sure, whereas the patient would be like, I'm I gotta go urinate blood real quick.

I'll be right back green, I'll give you feedback doctor. So that's a standardized patients right. Yeah, but there's there's plenty of other kinds. Let's take a um, let's take a break, and then we'll come back and talk about those. Okay, one thing before we move on to that I think we mentioned yet, is that, um, speaking of recessa Annie, they have these really expense of surgical dummies. Now they

think they actually they call them robots. Uh, and this is how surgeons practice now, um grand to a hundred grand. And I looked them up. These things are amazing and life like. Uh. They breathe and have pulses, and some of them bleed. They know how to love. Some of them give birth birth obviously, but uh, I kind of did wonder, like, how do surgeons even practice these days? I know they probably cut on cadavers in in med school,

but that you can only get so far. We've come a long way from the days where med students were forced to rob graves. Now we've got hundred thousand dollars cadillacts of robots ready for surgery. Yeah. I mean they look like I mean, some of them don't have if they don't need it. They don't have legs and arms, but they cover that up just to make it a little more realistic. But they have cuts. And this one dude I saw had like kind of a five o'clock

shadow beard. Um. It was creepy and awesome that they have this stuff that's so lifelike. Oh man. So I was on Twitter the other day shout out Twitter, um, and Atlas Obscura had this um tweet where they were They had a picture of this. It was a decapitated serial killer whose head was pickled in a jar from I think a teaching hospital and I believe Portugal, possibly Spain.

I think it was Portugal. It was Portugal, is like first serial killer and um, they had his head pickled and it was from eighteen forty when he was executed. And man, it looks like he was from the seventies maybe, like it's just so I mean, lifelike. Still it was completely undegraded and just creepy. And his eyes are wide open, just kind of like his mouth is a little slack, but he looks like he could be thinking about something rather than being headless. Well that's where the old race from.

A pickled head never loses its looks right. There's a T shirt all right. So if you're a recruiter, uh, let's say at the University of Pittsburgh, UM, and you're trying to find these people and source them, you're gonna be very picky, um because it's a it's a big deal. It's it's not like a fly by night job like this is something that medical students take very seriously. Uh, you have to be intuitive. Um, like you said, you had to weed through people that you might think have

some other sort of weird motive. Uh, but you know you're gonna have to weed through a lot of people because you know, this is also the kind of thing where you can make twenty hour so, um, you also want to I mean, obviously people want to get paid, but their motives have to be more than just money,

I think. Well, yeah, I mean it's it's tricky too because you you um expect you know how I caliber of commitment and and um skill from your your pay your teachers or your special standardized patients, right, yeah, and they're very highly trained and there's a lot of like um ongoing education that happens. Um. But at the same time, yeah, you're paid handsomely if you look at it per hour, but if you look at it over the course of a month even you're probably not even gonna be able

to make rent off of this. No, it's it's a part time gig if if that. But um, you know you have to be a good listener as well as all the things we mentioned like memorization and be a decent actor. You have to be able to take direction. Well, you have to be flexible if they change something up on you. Um, like if it says in here, if the simulation isn't achieving them is our goal. They you know, they may come in between sessions and say, hey, listen, I think we had the wrong approach here, So can

you can you do it this way right? Act better? I think that was Christopher Walkin said that was the only direction there was, really do it better? Yeah, but I love that guy. Yeah, don't we all so? UM? And you know, it's it's probably something you get into if you have a desire to help people, if you just have a zeal for interesting jobs, you know, yeah, maybe if you have an interest in medicine or psychology or being an educator like you're you're kind of you

are an educator in some ways. And if in fact, I think some of them call them, uh educators like medical educators. Yeah, there's a UM national association, a national group called the Association of Standardized Patient Educators UM, and I think they have like ongoing education and core curriculum and UM. It's it's pretty interesting to see just how

how much training you can get in this. And I imagine if you're really good and really highly trained you you you're not going to be some part time, you know, adjunct employee of a local medical school. You could conceivably go around the country or possibly the world, especially if you have a specialty. Sure, you know. One of the downsides of this is that, uh, and this is kind of a shame, but there there is no like controlled,

randomized trial that can actually prove the effectiveness. But by all accounts across the board, everyone says this is super important and highly highly effective as support students. It just can't prove it. Yeah, that drives them crazy. Probably. So so you've got you've got standardized patients one of the other ones you touched on. That's worth diving into a little more. Care actors, right, yeah, these are they fall

under that same umbrella of umulated patient. But these guys are um Whereas like a standardized patient is really going to help a you know, second or third year medical um student who has no clinical experience whatsoever and is learning the very basics of like physical exams or bedtimee

men or and all that stuff. A care acter is is much more useful for somebody who's already in practice and has a lot of experience, which just wants to get better at it right, So like a care actor will basically be there to add lib a little bit based on whatever the doctor wants to work on, Say

the doctor wants to work on empathy. Rather than go through the whole history and the whole patient encounter from beginning to end, they're going to focus on that one part of the patient and patient doctor interaction and they're gonna do it over and over again. There's an ability rather than having to start at the beginning and this at the end, you can stop and try something over again if you didn't like it or you want to

repeat it. Um. Like I said, there's a lot of ad libbing, and um, the doctor can say, okay, I want to We're gonna do a patient who has um psychosis and is in the midst of a psychotic break and it's on a scale of one to tenants and eleven, and I need to be empathetic, so let's try and then they're they're gonna go from there and they can just kind of switch it up as need be. Yeah, And I think this is really cool because the doctor

can get as specific as they want. They can say, like, you know what, I feel like I have a pretty good bedside manner, but I have a really hard time dealing with patients when they get angry at me. UM.

So they'll say, all right, let's let's dial up an exercise. Yeah, they're like, oh, you want something anger exactly you asked for it, and they'll bring someone in there, or like you said, if someone was if the doctor was like, hey, I do pretty well even with UM patients to have like a psychotic episode, but maybe not right in the middle of a psychotic episode. I've had some real trouble there. So they again, they come in there and like you said,

this is different. They're not surprised on what they're gonna get. This is just a very specific training method. Yeah, or the doctors like, I'm fine with kids unless they turn their eyelids inside out, and then I can't. I just completely lose it so cold you ever do that? But now I wasn't one of those either. I can roll my tongue perfectly and wi a my ears. Yeah, I can do those things too. I can't turn my tongue into like a clover club though, you know that kids

who could do that, Yeah, I can do that. I can't do that. I don't know I didn't know you could do that. Yeah, I hadn't pulled that one out in a while though. No, you got to. But the islet's saying, that's just there's no reason you do that unless you're you know, you're not gonna impress ross and you're not going anywhere in life if you're one up to the girls in class with your eyelids turned inside out.

There's no way to woo a girl. Young guys, young boys, if you're listening to this, don't don't don't don't do that. You know what you do Be nice to girls and listen to them, and trust me on that. I'm still learning that one. Are we all as we grow Now? I'm always nice, but I could always work on the listening. Sure, man, Uh was personal. That was good advice, Chuck. You know if you start out like a if you start a fifth or sixth grade boy out on the right track

like that, yeah, it canna be good humans. I feel like girls are inherently good. Sure you don't see girls running around with their eyelids turned inside out. Never, not even wonder woman would do that. Uh, that's true. What else? So you got standardized patients care actors and then there's UM. I ran across another one called unannounced standardized Patients. I'm not kidding. They they're basically you know what a secret

shopper is. Yes, they are highly trained standardized patients who are secret shoppers at hospitals and doctors offices and stuff like that to go in from beginning to end to rate the experience from the patient's eyes. Yeah. That's yeah, that's scary. Yeah yeah. But it's cool though that any hospital would do this because you know, it's it shows um a bit of a dedication to customer service, yeah, which I think that people forget that. You know, when

you go in for medical care, you're the customer. You should be treated well. Like we demand to be treated well from cable providers, from car dealers, from grocery stores, from everybody. But we just go into a hospital like complete supplicants, like please don't murder me, you know. And and if if you demand to be treat did like a a good a customer, well then well then they

do kill you. It's a conundrum. They're like, oh, I guess somebody shouldn't have mouthed off, and then the pillow goes over the faith you sent that one cool article UM of the doctor Uh what was he? What do you call himself? The MUDA that the guy who basically has recruited medical professionals that are self uh not actors, but you know, well they're they're medical actors. That did. Dude wasn't even a doctor, he was just a he

was a doctor. No, he was a freelance UM like teaching actor or or UM teaching patient, right, and he got really good at it and he specialized UM in male eurogenital exams, right, so prostrate exam, testicular exam. And this guy would travel the country UM doing this and he set up shop actually in Atlanta, a company called

UM Clinical Skills USA, right, and recruited other people. And these people are they just go around the country allowing medical students to give them rectal exams, breast exams, UM, vaginal exam, cervical exams, UM, so that they can these students can practice on a live person, but more than just a live person because in this articles articles by UM Elizabeth Coles and I think evocative, Well, these medical models use their own bodies as teaching tools and it's

really great. But she makes mention that apparently medical schools to train um MED students on gynecological exams. Back in the day, they would hire prostitutes. Did not know that. I didn't know that either. I thought these people, though, had medical background, because are training them as well, aren't they? Yes? A little to the left, little to the right, right there it is, Yes, So these people are trained in

the exam. They're not medical professionals. UM one's a one one that they interview is a real estate agent or no, an insurance agent. One guy's retired from that GM plant, which I suspect probably the one in Doraville. Um. No, they're just they they know what the exam is supposed to be like, and then they've subjected themselves to the exam so many times that they know the right way to do it so well that they can teach med students how to do it. But this is still under

the supervision of trained professionals, right. I have the impression that, like the the the med school teacher who brings these people in says, listen to what this person has to say. They're the trained professionals. All right, Wow, that's interesting. Yeah, So this one guy who's UM a male eurogenetic an auld teaching associate that they interview, um, Mike Manning. He said that he he estimates his head somewhere around four

thousand prostate exams man in nine years. Wow. So yes, that guy probably knows more about how to yeah, yeah, give a prostate exam than anybody in the world. Well. I saw the one picture, um of the guy like, you know, bent over the table. Uh, and it's from you know, his front and then the doctor student doctor behind him, and he's kind of looking back like you know, that's that's it. That's correct. Yeah, I think that was the guy. I think that was Mike Manning or Mark Manning. Yeah,

isn't it interesting? Yeah? I mean what a I don't want to call it weird, but what a just what a fascinating thing too to have a knack for and and not mind and just be like yeah four thousand times, so do it. Yeah, it's pretty pretty interesting that these the people who all work for him too, um are are They've kind of become a bit of a family. I love that they like go to bars and go

to dinner and hang out. Yeah, they do. Um. One of the one of them as uh, she's actually she would be considered a gynecological Teaching Associated g t A rather than m u t A. Her name is Katie Patterson, but like she travels the country teaching med students how to correctly insert a speculum um. I mean, like these people are literally donating their body to science. But while there's still a lot, I mean it's amazing. And yeah, they're getting paid, but I mean they're not getting paid

enormous amounts of money. They're getting paid something between thirty five and fifty bucks per student per day. So say you have ten ten students, you make ficks in a day. It's not bad at all, But you're only working thirty days out of out of the year. Maybe maybe fifty doesn't add up too much. So clearly these people are driven by by much more um benevolent thing than than moneyless their hearts. You know, yeah you got anything else,

I got nothing else? Son, turn out better than I thought, Chuck. Yeah, I think if you um, maybe if you're out there and you all this sounds like, hey, I could probably do that. And I have a desire to help people learn, and I don't mind being you know, poked and prodded, and I want to make a few bucks. Look into it. We should reiterate that the people who are the male eurogenital teaching Associates and the ladies who are the gynecological

teaching associates, they're very specific. And yes, you could say I want to sign up for rectal exams and they'd say, come on in, we need rectal exam volunteers. Bad. But um, just becoming a simulated patient of some sort. You could say I never want to do rectal exams. I just want to do you know, bedside man or something like that, and they would they would probably just stick to that, you know. Yeah, they're not going to force you to

ever do anything that you're not comfortable with. And again, regretfully, they don't give you any drugs. But if you do want that kind of thing, Yeah, if you are interested, check out your local mid school. They probably have some sort of program. Or again, go to the Association of Standardized Patient Educators. Bring in if you're an actor, beach waiting tables. Yeah, and in the meantime, you can type standardized patients into the search bart how stuff works dot com.

And since I said search bar, it's time for a listener. Uh, I'm gonna call this uh South Africa and Canadian All right, does pique your interest? Yeah, but I know what this one's about. Hey, guys, never really had a reason to get into contact into now since you announced your tour up to Canada, and that fired my cylinders into action. Listen to you, guys for a couple of years, probably from early to fifteen to been listening forever. I was

then living in South Africa. At nineteen, fresh out of high school, I made the daring decision to leave my family and friends try and make something of myself. I have Canadian citizenship as well, due to my father being born in Toronto or Toronto Toronto, so I landed there in Toronto early last year and made my way a little east and then a lot west to Vancouver, where I would be seeing you in September of this year.

The point is being away from family and friends is brutal at a nine hour time difference, and brutal turns to lethal. I often feel lonely or anxious of the future. And when this happens, stuff you should know, and the three of you, lovely people make it not seem so bad, as it feels like there's someone right here with me chatting casually about some neato topic it is. So I just want to say thank you for making this move tolerable when it feels sometimes not so great. Who's that

that is? K H? And I don't know if k E y A is Yeah, ka ka Kaya? I don't know how Kaya identifies on the gender spectrum. Well, who cares? Right? That's right, k H. They age sounds for how are you? I just want to use the right pronoun, you know what I'm saying? Sure, So what's that one? Is it sis? Sis? Gender like gender neutral? I'm not sure about they. I think they is like making a big, a big push right now? Well, a nice email from thy Yeah, thanks

a lot, Kaya, that's pretty awesome. Congratulations for striking out on your own. It's pretty amazing. And thanks for coming to our show in Vancouver, and even more than that, thanks for giving us a reason to plug our show in Vancouver and the rest of our tour where people can get tickets at s y s K live dot com and right all right, Well, if you want to get in touch with us, like KAA did, you can

tweet to us at s Y s K podcast. You can join us on Facebook dot com slash stuff as you know, you can send us an email to Stuff Podcasts at how stuff Works dot com, and, as always, join us at our home on the web, Stuff you Should Know dot com. For more on this and thousands of other topics, is it how stuff Works dot com.