"I can't believe that you don't have a brain injury!" Ordinarily these words might be an insult or cause for concern; today they were the best compliment I received all day. Today I was being a simulated patient in a ward with three others and a mannequin.
The patient had fallen off a ladder and now had a brain injury. Such a simple thing and suddenly this woman is confronting a completely changed life. Her walking, eating and cognitive function is affected. After my recent mishaps (the bag falling on my head and my knee injury) I have new perspective on the fragility of being okay and fully functioning in the world.
Be careful on ladders!
This week I've been working with different groups of students across the full spectrum of healthcare. Saturday and Sunday was the gynaecologists and obstetricians; Monday and Tuesday it was mental health nursing; Wednesday I was working with orthoptics students; today was nursing, physiotherapy, occupational therapy, social work, nursing and medicine and tomorrow, international medical graduates. It's such a privilege working with these students as they develop their skills and identity within their chosen field. Mostly they are excellent - really interested in people and ready to help; occasionally I notice that they've already lost their empathy. I think it's because they focus on skills and knowledge and forget there's a person at the centre of it.
Yesterday was the first time I've worked with orthoptists. They come with a lot of equipment and have spent their time practising their technical and clinical skills on each other. I noticed that many of them didn't explain what they were going to do before they approached the simulated patient. They would just lean over and peel the simulated patient's eyelids back and wonder why there was a reaction. The were great with equipment and not so great with the people. I asked if any of them had ever suffered the complaint that the simulated patient had (double vision). None of them had. I asked if they had considered what it would be like to have double vision. None of them had. I asked them who drove to university that day. Sadly most of them had. I asked them how they would have made their way to university if they had double vision. They started to think about life from the patient's perspective. Here was the "ah-ha" moment.
A few of the nursing students today had already developed what I call "nurse tone". There's a particular brand of condescension - talking overly loudly, slowly and using terms like "we" when they mean "you". I really hate that.
Working as a simulated patient has made me a better real patient. Talking to my GP the other day about a referral to a specialist, she asked me what kind of doctor I wanted. "A good one" was my response. She asked me if I was okay with someone who is very direct. Initially I said yes, but then I pictured myself in conversation about my particular issue with a very direct person. I realised exactly what I wanted AND what I didn't want: "I want to be a person, not a [insert body part here]." My GP selected a different doctor for referral.
I'm not sure I would have had the awareness of being a body part, or an illness before working as a simulated patient. Many times I turn up to play a role and am not referred to by my own name, let alone my character's name. Instead we gather to cries of "Lungs in here!", "Cancer in room three!" and "Depression follow me to the basement!". So the rot has started to set in as administrators and educators strip the person from the situation and turn us all into cases.
I push back, not moving until I'm referred to by one of my names. I correct people who say they've been happy to "use me" as a simulated patient, suggesting instead, it's a been a pleasure to work with them.
It's wonderful that health care education now gives students the opportunity to work with simulated patients as a proxy for real patients.
Spending the afternoon lying in bed, wearing pyjamas and talking to enthusiastic young people is a gig I love!