Simulated patients

As a former professor of psychiatry and a current simulated patient I was interested in the paper of Eagles et al (Psychiatric Bulletin, May 2007, 31,187–190). I have been doing such (voluntary) work for about 5 years, simulating psychiatric and general medical/surgical patients both for teaching sessions and in objective structured clinical examinations (OSCEs). I have also participated in OSCEs for higher exams for occupational health medicine but not yet for psychiatry. I find it a very interesting experience, and so far have not succumbed to the stress mentioned by Eagles et al. There is a bank of some 400 of us in Sheffield, a mixture of volunteers, actors, ‘real ex-patients’ and former clinicians of various specialties.

The usual practice is to be given a script about a week before, and once learnt one can usually trot it out realistically about 10–15 times in a day, spread over 4 or 5 sessions. I have been prepared to take on more or less any condition – the only one I drew the line at was that of a 27-year-old with schizophrenia; it wasn't the schizophrenia which troubled me, but I just could not satisfy myself I could act the 27 years convincingly. It was taken on by a younger actor.

We also lend ourselves for standard physical examination – blood pressure, temperature, chest examination, etc. In these days of MRSA, I was undergoing a chest examination in a rather draughty room; the young lad came in his white coat, duly washed his hands with alcohol rub, said ‘Oh my hands are cold’ and proceeded to rub them on his white coat to warm them before he put them on my chest. Does he get failed for poor hygiene, or a distinction for concern for the patient's comfort?

Another heart-warming incident occurred at the end of a lecture in which I was demonstrated as a widowed hypertensive patient living alone who was worried in case he collapsed and fell down the stairs. A young student came up to me and said, ‘I hope you don't mind me telling you, but my granny is like you, but she has an alarm round her neck and she can call for help if she needs to.’Another distinction.

On one occasion I was there for an abdominal examination when one of the demonstrators was called away for an emergency. I found myself taken out of bed and reverted to being a doctor, teaching for the rest of the morning.

You can appreciate I find it a rewarding, entertaining and amusing experience, perhaps repaying some of the satisfaction I achieved during my teaching and clinical career. I think it is true to say that the majority of my fellow simulators, whatever their background, feel the same way, putting something back into the system in return for whatever help they have gained in the past – it is our National Health Service.