Actor and former nurse Susan Greenfield helps medical students with their interviewing skills and communication skillsGetty Images/iStockphoto
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One role I used to play was a woman with schizophrenia, saying very bizarre things, screaming at people, seeing visions and thinking she's being invaded by aliens.
The role was that she was actually a physician herself, and she was kind of having a breakdown, where she's thinking these alien spaceships are coming down to take over the world and it's her job to get everyone to Queen's Park before it happens.
The drug-seeker roles are pretty fascinating too, where you're trying to be very manipulative. And one that's always pretty fun is when you're playing a boundary-crosser, where you're trying to get really affectionate with the physician or student. You're just pushing all their buttons, asking them to go out for coffee or complimenting them on how beautiful they are. They have to find ways of setting up boundaries and then you get upset.
As standardized patients, we do different roles for the practical part of the examinations for doctors who are getting their licence to practise in Canada, and for pharmacists, physiotherapists and all that sort of thing. This was where standardized patient work originally began, as a way to test people on their ability to gather information and communicate with people to make a diagnosis and make a plan for the exam.
The faculty of medicine now uses standardized patients right from day one with its med students. We're helping them with their interviewing skills and communication skills, so they get exposed to us throughout their whole training.
We do a lot of basic things, such as panic attacks, migraine headaches, anxiety and depression. There's also situations where you have to be told a loved one has died of a heart attack, for example, or you're told you have terminal cancer.
It's always interesting playing psychiatric roles, such as a manic patient where you go in and you literally never stop talking. Those roles are exhausting too. We also do a lot of roles where there's a physical component, such as if you have appendicitis. You have to know how to react when they do a physical exam and they're poking and prodding.
For the licensing exams, the exams happen all across the country, so everybody is taught the same roles. Everybody has to give each candidate who comes through the same basic experience and that's why we have to standardize the responses and the level of affect and everything. You're almost like a walking checklist.
I think everybody gets a bit nervous, especially for the first couple of rounds because you want to give every single candidate the best experience possible. You get more and more sure of yourself as the day goes on, but you do go into it thinking, "God, I have to be good right off the bat." And the other thing is the people who are doing the exams – and even in the teaching situations – those people are always incredibly nervous. They take it very seriously. It's not a game.
In the teaching situations, what you're really hoping to do is demonstrate the effect of the student's behaviour on how you can answer their questions. We call it "teaching in role," so if somebody is using a lot of big words and stuff, you can say, "I have no idea what you're talking about. Can you just please explain it to me in a way I can understand?"
We also give feedback so people understand how their behaviour affects us as patients. It's quite wonderful to watch students when the light bulb suddenly comes on and they realize how they can interview more effectively. It can really change someone's approach radically.
And for me, I feel so much more respectful of what people have to deal with when they're experiencing mental- or physical-health problems. It raises your empathy. You recognize how challenging it is for people.
It's also made me very aware of how other people relate to me when I'm in situations myself, like when I'm going to a doctor's office or having to have procedures done or whatever. I get, not angry, but disappointed when I'm with someone who isn't listening to me or is in a hurry and I don't feel cared for. I always just want to say, "It wouldn't take very much to look me in the eye and say, 'Oh, I'm sorry that happened to you,' or whatever."
But on the other hand, when I do meet people who are wonderful and do take the time to communicate, I quite often will write a note and give it to the office to say I appreciated it. I think it's important for people to know what they're doing is effective.
It's very interesting work. It's a really good education in being a human being.
Susan Greenfield is an actor and former nurse, who has been role-playing various medical conditions for around 20 years. She is also a standardized patient trainer with the standardized patient program in the faculty of medicine at the University of Toronto.
As told to Wency Leung