Pretending to be Ill

Pretending to be Ill
2018-12-17

The following article appeared in the Winter 2018 issue of "Third Age Matters".

Patient-doctor role-play is an invaluable medical training process, extending the emotional range of everyone who takes part, says Dr Stuart Hannabuss, a writer, retired academic and lay chaplain at the University of Aberdeen.

"As we age and experience ill-health, we rely more on accessible healthcare and medical staff with the knowledge to diagnose symptoms and identify appropriate cure pathways. This knowledge is not only medical or clinical: it is also about communication and empathy.

Today many UK health trusts tackle these issues by running patient simulation programmes.

Although the media often imply that the NHS is bureau­cratic and impersonal, the truth about most medical encounters is quite different. We remember the kind nurse who really listened, the surgeon who fixed the operation, the consultant whose advice was wise and compassionate.

It is important for young doctors to develop this communication and empathy. Opportunities to talk with patients, in safe and confidential ways, form an essential part of their training. Dealing with patients who are angry or confused, frightened or vociferous, is a skill all of us need to develop.

Many patients present with symptoms that need diagnosis; others appear unable to articulate what is wrong; yet others resist or resent the questions doctors and nurses must ask. Personal narratives are often confusing, especially when family members join in, above all when there is a crisis.

When something is badly wrong, most lay people fear the worst. Why is this happening to me? Why can't I just get on with my life?

Patient simulation programmes go by different names, but most share scenarios in which a doctor (or dentist) interacts with a volunteer who role-plays a plausible patient.

Some involve a medical examination, others only a conversation, which can still be a demanding test of the student's medical knowledge and emotional sensitivity.

The doctor-patient interaction should be as realistic as in real life. When actual patients present to doctors and nurses, in surgeries and clinics, there is a wide range of scenes and scenarios, encounters and conversations. Simulations are no different.

Simulations not only pinpoint the student's medical ability to identify treatment options, but also extend the experience of the volunteers, enabling them imagine themselves in the shoes of patients with conditions that they them­ selves may never have.

A valuable part of a simulation is feedback, not only from tutors and students but from volunteers. For the "patients' being able to articulate how they felt about a student's diagnosis, and how the student interacted with them on a human level, is important not only in simulations but in reality.

Feedback also enables "patients" to reflect upon their own experience of illness. Many volunteers are older people, keen to give something back to the community and learn new skills. They know too that their friendship with the NHS is likely to become stronger as they get older.

Some valuable lessons emerge for all of us, not just for the students training to become the GPs and hospital doctors of the future. Simulation may seem to be just pretending to be ill, but in fact much more is going on. Participants learn to project themselves into any plausible medical situation.

Simulation is one of the best ways to develop and apply empathy in creative and imaginative ways and in confidential settings. It enables all of us - hardened veterans as we think we are in the university of life - to learn about ourselves, reflect about health and illness and sharpen our understanding of what we want and expect from medical staff when we or our loved ones are ill."

 

Published by The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen

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