TIME: Almanac 1993/TIME Almanac 1993.iso/time/122391/1223350.000

Text File | 1992-08-28 | 6.1 KB | 125 lines

                                                                                MEDICINE, Page 53

A Lesson in Compassion


What's it like to be a patient? For more and more aspiring
doctors, there's only one way to find out.

By ANASTASIA TOUFEXIS


    Ellen Weiss can hardly see. David Schmitt can barely
hear. Together, the elderly woman, who suffers from diabetes,
congestive heart failure and arthritis, and the widower, who is
recovering from a hip fracture, slowly shift through the halls
of Hunterdon Medical Center in Flemington, N.J. Typical victims
of aging's cruelest blows? Not really. Weiss is actually a
resident in family practice, age 30, and Schmitt a medical
student, 26. They have been assigned roles, ages and infirmities
as an innovative part of their medical training.

    Introduced in only a few medical centers so far, such role
playing is designed to expose doctors to the anguish endured by
the infirm. It is just one of several techniques being tried at
U.S. medical schools and hospitals in an attempt to deal with
the most universal complaint about doctors: lack of compassion.
"Residents are usually young, healthy, privileged," says Dr.
Stephen Brunton of Long Beach Memorial Medical Center in Long
Beach, Calif. "They've not really had a chance to understand
what patients go though."

    Role-playing programs give them a crash course. At
Hunterdon, students' faces are instantly aged with cornstarch
and makeup. Next the disabilities are laid on: yellow goggles
smeared with Vaseline distort vision, wax plugs dampen hearing,
gloves and splints cripple fingers, and peas inside shoes impair
walking. Then the ersatz invalids are asked to perform common
tasks: purchasing medication at the pharmacy, undressing for X
rays, filling out a Medicare form and, most humiliating, using
the bathroom.

    At Long Beach, new residents in family practice assume
fabricated maladies and check into the hospital for an overnight
stay -- incognito. The staff treats them as they would any other
patient, even sending them a bill. The entire entering class of
medical students at the Uniformed Services University of the
Health Sciences in Bethesda, Md., are issued bedpans and told
to use them. They spend part of the first day of school as
hobbled patients. A few male students are even subjected to an
indignity familiar to women: waiting in the stirrups for a
doctor to arrive.


    Instant patients start out peppy and joking. "But by the
end of a few hours, most say, `I'm exhausted,' " observes nurse
Linda Bryant at Hunterdon. Schmitt discovered that "a major
accomplishment was doing up my collar." And, to his surprise, "I
wound up resenting physicians who didn't realize how much
medication would cost and how hard it was to go and pick it up."
Weiss also had an epiphany: "I realized how little I talk to
patients. I might ask them about chest pains but not `Can you
get dressed, eat O.K., take your medicine?' " At Long Beach,
Jeffrey Ortiz thought he was in for a quiet rest when he was
sent to the intensive care unit, suffering from "chest pains."
Instead he spent a sleepless night: "People were coming in to do
labs, the man in the next bed was groaning, and the heart
monitor was bleeping. It was noisy and scary."

    Any patient could have told him so, but many educators
believe the direct experience of such miseries will leave an
enduring sense of sympathy. Doctors have long defended taking
a cool, dispassionate approach to patient care, arguing that it
helps preserve objective judgment and protect against burnout.
But critics disagree. "By concentrating on symptoms and lab
data, we ignore a wealth of information that can affect
patients' well-being," observes Dr. Simon Auster at the
Uniformed Services medical school. Moreover, he says, "it takes
less energy to get close to a patient than to maintain a
distance." Auster warns, however, that caring should not be
confused with wallowing in soppy feelings with patients or
adopting an appealing bedside manner. "That's superficial
charm," he declares, as opposed to the more difficult task of
grappling with the painful emotional issues in medicine.

    To lure more caring individuals to the field, schools are
seeking older students as well as non-science majors. Reformers
are also revising the curriculum to place more emphasis on how
to relate to patients. Some schools have engaged actors to
portray patients -- some of them ornery or withdrawn -- whom
students must then interview and counsel. At Duke University's
medical school in North Carolina, Melanie Wellington had a tough
time with "Tom Brown," a black man in his 50s, whose dietary
habits were contributing to high blood pressure. "Brown" said
he didn't want to be treated with drugs because medication had
ruined his brother's sex life. Says Wellington: "The biggest
problem was my own discomfort," particularly when it came to
asking him about his sexual history and possible drug abuse,
which drew hostile responses. "Now I preface my interviews with,
`These are questions we ask everyone. We need the answers to
take the best care of you.' "

    Such educational experiments are not a panacea, but
already they are yielding some symptomatic relief for patients.
At Long Beach, the residents' experiences as patients-for-a-day
have prompted administrators to accelerate the hospital's
admissions process: it now takes 15 minutes or less. Other
results are harder to measure but just as significant. Robert
Stambaugh admits that he felt "self-conscious and silly" during
his brief stint impersonating a patient at Uniformed Services.
But two years later, he drew on the experience to summon up
sympathy for an obstreperous patient whose brain had been
injured in a car accident. "He'd throw bedpans, pull out
catheters and verbally abuse everyone," Stambaugh recalls. As
the student doctor who had to repeatedly replace the catheters,
he was tempted to blow his own top. "On reflection, though,''
he says, "I recognized that the patient was scared to death,
confused and had lost a great deal of his dignity. That was what
made me able to deal with him."