When it comes to acting ill, Diane Bulan is a veteran.
"I've been sick for quite some time," jokes Bulan, a perfectly healthy Kansas City actor who has worked as a "standardized patient" for about 15 years.
The use of simulated patients started in the 1960s, as a way to evaluate the clinical skills of medical students. The concept was simple: Instead of finding people with a particular malady that students need to learn how to identify, use an actor. Medical educators since have found the encounters go a long way in preparing students for real-life situations.
A system was eventually developed to standardize the process (this is a science, after all) thereby ensuring each med student saw the same set of maladies in a simulation, and each actor was exhibiting them in the same way.
"It's important for all students to receive the same level of training, and in clinics it's challenging for everybody to see the same patients," says Courtney McCain, who coordinates the standardized patient program for the UMKC School of Medicine.
Standardized patients make that challenge easier to overcome, and having experience with them is a requirement for medical students in the United States.
For today's students, the simulations are about more than just being able to identify that, say, someone needs their appendix taken out. The exercises play an invaluable role in developing a future doctor's communication and professionalism.
"If a patient feels dismissed or if a patient feels condescended to ... they're not going to want to come back for health care," says McCain.
For the actors involved, the work can be fairly demanding. Not only are they responsible for knowing their patient role inside and out, they also have to know whether the student in question is correctly performing an examination.
On top of all that, they need to be able to identify very specific ways in which an encounter went wrong, or went well: Did the student ask about family medical history? Did they perform the required physical exams in the correct order? Did they make the patient anxious by clicking their pen through the entire appointment?
"It's not easy, and it's not for everyone. We are looking for people who are versatile, they are well-spoken, they are people who are flexible," says McCain. "And there does need to be a very strong improvisational component to this."
That's because in a typical simulation, an actor recieves nothing more than their character's background and situation, an opening line ("My legs have been bothering me," for instance), and a detailed description of the condition or symptoms they've been assigned.
"Most encounters start within the clinic setting, so you're already waiting for the doctor or nurse or whomever to come in," says Bulan, who does this work at several medical institutions in the area.
After that it's off to the races, and the best actors make sure they're prepared to answer whatever questions a good doctor might ask.
"It's up to the students to ask the questions, and the standardized patients are trained not to give them any information that they didn't ask for," says McCain. "So it becomes very formative for the students."
For Bulan, the memorization, improvisation and interrogation have become familiar.
"After doing it for a while, I get into a routine of being able to memorize a lot of information in a short amount of time," she says.
Plus, it makes a great ice-breaker whenever she visits the doctor's office.
"It's always fun to joke with them. I can talk about, 'That was really good compassion that you showed for me,' or 'That's really good empathy and humanism you displayed right there, so good job!'"
Bulan has yet to give her own physician a negative assessment, but says the real reward of the job is knowing she's helping future patients get better medical care.
"I hope that future health care professionals will go on to be better verbal communicators, and be able to show the empathy and humanism that we trained them to express," she says. "That's the most fulfilling, important thing that is part of my job."