Today, I am a 40-year old with type 2 diabetes. I have been on glyburide since I was diagnosed four years ago and am otherwise healthy, although my blood pressure today is 140/96. I don’t check my glucose levels at home because I don’t have a monitor. Typically, I avoid sweets, but my diet is high in natural sugars, carbohydrates and starches. The only exercise I get is walking around on the floor of my retail sales job. My diabetic mother died of kidney failure, and I don’t want that to happen to me, which is why I’m seeing my doctor today.
Today, I am Lucy. Tomorrow, I will be someone else.
In real life, I’m a professional standardized patient (SP). For over a decade, I have played hundreds of characters in order to help train thousands of doctors. At last count, I estimate that I have been seen by well over 8,000 students, interns, residents, fellows and other medical professionals. Today, as Lucy, I will add another five doctors to this list.
Being an SP has taught me many things about doctors, medicine, and patient care. The best doctors are those that excel in both medical knowledge and patient communication. Sadly, from my experience, only a small minority of medical practitioners are excellent communicators. Most are OK, but some are downright terrible. Nevertheless, I have seen even the worst of these communicators make progress in this arena and, like thousands of other SPs, I take pride that the training we provide allows them to improve in a safe environment where mistakes are seen as learning opportunities and not failures.
After thousands of encounters with medical practitioners, it still amazes, fascinates and frustrates me how much a doctor’s own experiences and opinions shape their treatment and care of a patient. These doctors have exactly the same training, lectures and curriculum as their colleagues. Despite being told exact questions to ask patients, as well as specific treatments to prescribe, each encounter with a doctor is a very different and unique experience.
In each of my five encounters today, Lucy’s details are exactly the same. My goal is to play the role the same way each time, so every student has an equal experience. Yet despite the standardization on my part, I receive five very different treatment plans from my doctors today.
All the doctors I saw today were supposed to interview me about my medical history, family history, and lifestyle (to include diet and exercise), plus perform a short physical exam. All of them were to provide me with a treatment plan on how to better manage my diabetes so I wouldn’t suffer the same fate as my mother. All of them did this, although the range of advice varied greatly.
Doctor number one overlooked the fact that I need to make some major changes to my diet and exercise, and I was told that both were perfectly fine. He told me my blood pressure was a bit high, and he would monitor it at future visits, and that I should purchase a glucometer, but that was the only advice and treatment I received from doctor number one.
Doctor number two had more to say when it came to a treatment plan. He said my blood pressure was too high and I should purchase a machine to monitor this, and that I needed to cut carbohydrates and starches out of my diet, plus exercise 30-minutes a day at least three times a week. Nothing was said about checking blood sugars at home.
Like number one, doctor number three told me my diet was just fine, and my current exercise regimen was great. My blood pressure was OK, but perhaps my cholesterol should be checked, and I should be put on meds for both since I was a diabetic. No advice was given regarding my current medications or blood sugars.
Doctor number four had no problem with my diet, or with my level of exercise. She wanted to change my medication from the glyburide to metformin and recommended I get a glucometer. She also told me that while my blood pressure was OK, it might be a good idea to get a blood pressure cuff.
The last doctor I saw was the most thorough with her treatment plan. She was not perfect, but she was the only one who checked in with me to find out what I understood about my illness, asked how I felt about the treatment options presented, let me process everything she had said, and then reviewed the treatment plan. She told me my diet and exercise needed work, added a statin and ACE inhibitor to my meds, instructed me to get a glucometer, and recommended an annual visit to both an ophthalmologist and a podiatrist.
Today’s five interactions illustrate important truths that I have learned from the more than 8,000 SP encounters that came before. First, even in standardized scenarios, the range of medical advice often varies greatly from one doctor to the next. Even though these are still students with a lot of years of training ahead, my real-world visits with licensed practicing physicians make me suspect that this wide variation of advice and treatment is not exclusive to medical students at all but rather, is quite common even in the fully-trained medical community.
Most patients won’t seek out more than one provider for routine health maintenance or are unable to do so, since that, in and of itself, is challenging. The range of medical advice varies so greatly from one doctor to the next that for those, like Lucy, who are in doubt of the prescribed treatment plan, I say always seek a second opinion. It could make a difference for your health.
Esther Covington is a professional standardized patient.
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