Feigning sickness to improve healthcare

After a life-altering diagnosis, a ‘standardized patient’ does her part to improve doctor-patient communication

doctor listening to patient
Image Credit: Sarah Lazarovic

An extended audio version of this story can be heard on Episode 21 of Work in Progress, Slack’s podcast about the meaning and identity we find in work.

Not everyone we encounter day-to-day is as helpful as we’d like them to be in certain situations.

But when it’s a doctor doing a poor job counseling you as a patient, it can be especially upsetting. When we seek the care of a doctor, we’re often at our most vulnerable — we’re looking for help and support from an expert.

Medical schools in the U.S. and Canada recognize this and include in their instruction some basics on doctor-patient interaction with an eye towards improving bedside manner. Most people don’t know that schools even bring in people to take on elaborate fictional roles, acting as patients with a full backstory and list of symptoms, who then get examined and answer questions from students.

The people taking on this work are called simulated (or standardized) patients, and it’s now part of required testing for doctors before they can practice medicine in the U.S.

Years before medical students touch a real patient, they practice on people like Lyn McCauley. McCauley acts out her roles and endures repeated poking and prodding amidst all the questions from students. For her, it’s as simple as responding to occasional requests. “We get an email saying, ‘Are you available the next day for carpal tunnel or heart disease?’,” she says, “and we sign up.”


“The doctor said to me, ‘Oh. By the way did we tell you you have MS?’,” says McCauley.


Being a standardized patient is difficult. It doesn’t pay well and it’s not steady work, plus you have to endure a dozen back-to-back breast exams or checks for appendicitis.

So why does McCauley do it? Because she’s seen first hand the difference it can make.

When McCauley was 19, she was diagnosed with multiple sclerosis, and she got the news in the worst way possible—off-handedly, over the phone, and while she was at work.

“The doctor said to me, ‘Oh. By the way did we tell you you have MS?’,” says McCauley.

She was overwhelmed. She had gotten news of a serious life-changing illness, but wasn’t getting enough information or support from the person she trusted with keeping her healthy.

She never forgot her frustration from that experience and it drives her to help medical students do a better job today.

Standardized patients make real the lectures about anatomy and symptoms students absorb for years in school. They also let students connect with patients before they ever work with actual ailing people. If a new doctor mishandled their first cancer screening on a real patient, the consequences could be dire. But in a classroom, it’s alright, and the procedure can be restarted when mistakes are pointed out.

Then there are situations that medical students can’t otherwise practice for, but still need to be prepared to do once they become doctors. They are moments doctors dread, like the first time they tell someone they have an aggressive cancer with a low survival rate, or getting to practice what to say when a patient is seriously considering suicide.

“It’s that reality, that recognition of what they’re dealing with is a human being, not a disease,” says McCauley. “You start that really early on in their career, and keep reinforcing it — you’re going to come out with a better professional medical person.”

Today, as a standardized patient evaluated by medical students, McCauley’s doing her part to make communication between doctors and their patients better, more compassionate, and more human.

As she puts it, “I hope they appreciate the fact that people like me, doing this work, especially the ones who do the more extensive work, are really anxious to be part of an improved medical system, and do our part.”

Work in Progress story produced by Dan Misener.


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