Advice: how can I fake it better?

[basupran]

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I am very confused about this, but here goes. Our school is placing a lot of emphasis on the OSCE exams which are basically simulated patients trained to act a certain way. I haven't had much difficulty in getting the clinical diagnosis, but I am getting remarks like "you didn't establish a rapport with me and didn't show empathy". In the back of my mind, I know that this is a fake patient with a fake clinical scenario and I have a hard time simulating empathy. I am pretty empathetic in real life and don't have a hard time getting along with my patients but I always feel this uncomfortable feeling when I am with a simulated patient. So how can I fake being genuinely concerned when I hate rattling off 'oh my goodness, that must be so hard'.

 

[MDpride]

If your patient says her/his parent had a stroke when u ask family history, recommended/suggested response is " I am sorry" with appropriate body language.

 

[Simmy]

I am very confused about this, but here goes. Our school is placing a lot of emphasis on the OSCE exams which are basically simulated patients trained to act a certain way. I haven't had much difficulty in getting the clinical diagnosis, but I am getting remarks like "you didn't establish a rapport with me and didn't show empathy". In the back of my mind, I know that this is a fake patient with a fake clinical scenario and I have a hard time simulating empathy. I am pretty empathetic in real life and don't have a hard time getting along with my patients but I always feel this uncomfortable feeling when I am with a simulated patient. So how can I fake being genuinely concerned when I hate rattling off 'oh my goodness, that must be so hard'.

If the "patient" is in a bed; Do the diagnostic work while smalltalking to the patient (BP, breathing etc), talk in a calm steady manner. When finishing up the diagnostic work: Sit down on the bedside explaining carefully (stil calmly) the diagnose and the different solutions you have. Also re-assure the patient that he/she will get the best care you can give them etc blablabla


Ok.. Im only a first year student, so I have jack **** of clinical experience. But I am pretty good when it comes to people skills..... Its all about making the patient feeling that he/she is in good hands, that you are generally intrested in them and that you WANT to help. Keeping a calm manner will make them more comfortable and eyecontact and a warm hand is gold....

Just imagin this:
Stressed out doctor comes into patients room. Lookes through forms and stats while giving just small comments to the patient without making eye-contact. The doctor is fast and mechanic (robot like) when it comes to doing the check up.....

Ive worked in a reception at at gym for many years. Every month we got feedback from a "mystery trainer" who was a random member picked out by the company to give us anonymous critique... We often got complaints that the people in the reception acted to "mechanical/robot like" in their actions without giving eye contact. This made the member feel that we didnt care about them and just did stuff on comand... This was EVEN if we said hello/goodbye to them and smiled...

Hope this helps

 

[WellWornLad]

Maybe you're too good. Small talk and rapport is what I'm doing while I try to remember what else I was supposed to be doing.

 

[turkeyjerky]

Just do the fake empathy ****. If they have a headache, ask if they want the lights turned down, etc. Stuff like "that must be difficult" or "how are you coping with that" or "yeah, you seem to be in a lot of pain" (that one's great if they act completely normal, but the pain is an 8/10), remember PEARLS.


Don't be ashamed to say stuff you'd never actually say in real life, they're just waiting for you to say something so that they can check off a box. The fake patients always seem to be pretty weird people anyway, it's tough to relate to them regardless, so just be shameless with faking empathy.

 

[Mattabet]

Just do the fake empathy ****. If they have a headache, ask if they want the lights turned down, etc. Stuff like "that must be difficult" or "how are you coping with that" or "yeah, you seem to be in a lot of pain" (that one's great if they act completely normal, but the pain is an 8/10), remember PEARLS.


Don't be ashamed to say stuff you'd never actually say in real life, they're just waiting for you to say something so that they can check off a box. The fake patients always seem to be pretty weird people anyway, it's tough to relate to them regardless, so just be shameless with faking empathy.

👍

At the very least, this is fertile ground for side-bets. Who can fake the most empathy?

 

[xanthomondo]

By the title of this thread I thought it was going in a way different direction.

...dissapointing 🙁

 

[ACSurgeon]

I am very confused about this, but here goes. Our school is placing a lot of emphasis on the OSCE exams which are basically simulated patients trained to act a certain way. I haven't had much difficulty in getting the clinical diagnosis, but I am getting remarks like "you didn't establish a rapport with me and didn't show empathy". In the back of my mind, I know that this is a fake patient with a fake clinical scenario and I have a hard time simulating empathy. I am pretty empathetic in real life and don't have a hard time getting along with my patients but I always feel this uncomfortable feeling when I am with a simulated patient. So how can I fake being genuinely concerned when I hate rattling off 'oh my goodness, that must be so hard'.

Some of your patients might provide a history based on a previous illness or experience. So, whether they really have (or had) the problem they're presenting with is not really known to you. Thus, you should think of it as faking, but as practicing (which is what it's intended for anyways)

 

[Warbux]

By the title of this thread I thought it was going in a way different direction.

...dissapointing 🙁

Haha I thought the same thing

 

[Concordia]

How would you want your mother, father, or SO be treated at a doctor's office? Think about that and try to incorporate these considerations when you see a fake patient. That's what I do to help me dredge up some empathy...I generally don't like people too much

 

[jonb12997]

I agree that the whole fake patient thing is stupid... my feeling is that if I can do 2 years of clinicals at a US hospital and not have anyone, patient, nurse, doctor, etc. say anything to me about my bedside manner, then I must be doing something right, and I should be allowed to graduate without having to do the stressful fake patient exams. I agree that I'm fine with normal patients, but when you put me in a testing situation, I get all nervous...

 

[SpookyDoc]

By the title of this thread I thought it was going in a way different direction.

...dissapointing 🙁

Screaming + fingernails.

 

[smq123]

I am very confused about this, but here goes. Our school is placing a lot of emphasis on the OSCE exams which are basically simulated patients trained to act a certain way. I haven't had much difficulty in getting the clinical diagnosis, but I am getting remarks like "you didn't establish a rapport with me and didn't show empathy". In the back of my mind, I know that this is a fake patient with a fake clinical scenario and I have a hard time simulating empathy. I am pretty empathetic in real life and don't have a hard time getting along with my patients but I always feel this uncomfortable feeling when I am with a simulated patient. So how can I fake being genuinely concerned when I hate rattling off 'oh my goodness, that must be so hard'.

Unfortunately, for the standardized patients/OSCE, you can't just rattle off words. Just saying, "Oh that must be so hard for you" isn't enough - you have to show them in other ways. Since physical contact can be a bit iffy, I usually opt to paste on an "empathy face." For me, that's usually a slight frown, and then I gently squinch up my eyebrows, to make it look like I'm really...really...listening.

It's kind of like going to a cocktail party and being forced to make small talk with your boss's wife. You're kind of pretending an emotion, rather than actually feeling one.

Also remember that many SPs are the most hyper-critical humans on the planet. They will nitpick everything you do and say.

Waste of time to be forcing students to show empathy and such.

Agreed. OP - it's much easier to show sincere empathy when you're an MS3, and actually have a sick patient in front of you....as opposed to a mediocre actor. It's easier to feel genuinely sorry for someone who actually DOES have cancer, instead of someone that you know is acting.

 

[tkim]

The only places you can touch non-clinically is to shake hands and perhaps a hand on the shoulder.

Simulated patients are either really ****ty actors who do it as a job to make money, or people who had bad patient experiences and want to take it out on the medical community. It's a tough crowd either way.

I'd advise thinking about someone you actually know who actually has a condition and act as if you were talking to them about their problem.

I'm assuming you busted out the Oscar performance for med school - who didn't. Dust off the statue and get to work.

 

[Impromptu]

I am very confused about this, but here goes. Our school is placing a lot of emphasis on the OSCE exams which are basically simulated patients trained to act a certain way. I haven't had much difficulty in getting the clinical diagnosis, but I am getting remarks like "you didn't establish a rapport with me and didn't show empathy". In the back of my mind, I know that this is a fake patient with a fake clinical scenario and I have a hard time simulating empathy. I am pretty empathetic in real life and don't have a hard time getting along with my patients but I always feel this uncomfortable feeling when I am with a simulated patient. So how can I fake being genuinely concerned when I hate rattling off 'oh my goodness, that must be so hard'.

Everyone likes to think of themselves as naturally good at what they do, but you are likely not as empathetic in real life as you imagine yourself to be. Swallow your pride and look at this as an opportunity to improve your real-life patient rapport skills, which takes conscious effort and hard work. If you believe you are already good enough, then you won't improve.

 

[OncoCaP]

I am very confused about this, but here goes. Our school is placing a lot of emphasis on the OSCE exams which are basically simulated patients trained to act a certain way. I haven't had much difficulty in getting the clinical diagnosis, but I am getting remarks like "you didn't establish a rapport with me and didn't show empathy". In the back of my mind, I know that this is a fake patient with a fake clinical scenario and I have a hard time simulating empathy. I am pretty empathetic in real life and don't have a hard time getting along with my patients but I always feel this uncomfortable feeling when I am with a simulated patient. So how can I fake being genuinely concerned when I hate rattling off 'oh my goodness, that must be so hard'.

It sounds like the OSCE makes it hard for you to "be yourself" with respect to empathy and rapport. This is not unexpected because it's difficult for most medical students to be highly empathetic toward someone who is endorsing certain symptoms for the purpose of judging the student's knowledge and skill. I remember thinking with my last standardized (neuro) patient ... hmm the sensory level is different in the front and back ... my differential is mostly psychiatric at this point . I even had a hard time writing my "standardized" note as a result.

In my opinion, the key is not to fake it when it comes to empathy and rapport; you have already said that you have the goods, and you just need a way to be able to do what you would normally do with a "real" patient (i.e., emulate your empathy that is present when you are not in a testing situation). The first thing might just be dealing with any anxiety that you may have. When I get nervous, I might talk a little faster than I normally do, and sound less empathetic. Maybe something like that is happening when you take your OSCE. If you get a bit nervous, you might make sure you are more relaxed by doing whatever you normally do for that, such as listening to music that relaxes you, exercising or stretching, breathing exercises, humor, etc. When you talk to the standardized patient, you might "visualize" a real patient.

You might also ask if it would be possible to get more specific feedback (what exactly did you do that indicated you were not empathetic or how did your efforts to establish rapport not meet the mark). Our standarized exams are videotaped and we can (in fact, are encouraged to) review them with an instructor or mentor and get very specific improvements for suggestions.

My own sense is just to give this some time. Who knows, you might find a patient in real life that you have difficulty being empathetic toward and manage to establish good rapport anyway. Maybe your standardized patients are supposed to give you something to work on and your physical exam was just so perfect, they had nothing to suggest except empathy as a possible area of improvement 😀. No need to obsess. Everyone is in the same boat, everything is going to work out.

Take care and Good luck!

 

[Veg]

Unfortunately, for the standardized patients/OSCE, you can't just rattle off words. Just saying, "Oh that must be so hard for you" isn't enough - you have to show them in other ways. Since physical contact can be a bit iffy, I usually opt to paste on an "empathy face." For me, that's usually a slight frown, and then I gently squinch up my eyebrows, to make it look like I'm really...really...listening.

It's kind of like going to a cocktail party and being forced to make small talk with your boss's wife. You're kind of pretending an emotion, rather than actually feeling one.

Also remember that many SPs are the most hyper-critical humans on the planet. They will nitpick everything you do and say.



Agreed. OP - it's much easier to show sincere empathy when you're an MS3, and actually have a sick patient in front of you....as opposed to a mediocre actor. It's easier to feel genuinely sorry for someone who actually DOES have cancer, instead of someone that you know is acting.

It's really not a bad thing to be able to fake it a little anyway. You're going to have patients that get on your nerves. You're going to have a long day and not want to listen to anyone else complain (even if it is valid).

"That must be hard"* is not a bad thing to work into your H&P routine since eventually you're going to be doing the whole thing on autopilot a lot of the time and it does often get left out in real life.

*My personal favorite was a geriatrican who made liberal use of the phrase "Oh my goodness". It's completely non-commital and can be used in response to complaints, compliments, compilance (when it happens), etc. Genius.

 

[VoiceofReason]

i got dinged by an SP for chewing gum

I HATE the osce

 

[LumberJack]

i got dinged by an SP for chewing gum

New Jersey.

 

[smq123]

It's Gen surgery anyways, the surgical patients get their surgery and you never see them again. I bond more with the hospitalized patients where I'm actually with them for more than 15 minutes asking them how they are doing every now and then rather than the informality of the external consults.

Really? 😕 That's interesting. So you don't round on them the next morning after they're recuperating from their surgery?

In the US, the surgeons who operated almost always stop by and check in, even if another team is taking care of that patient.

So, in Mexico, who takes care of the patient after the operation?

I do think that these actors should remember that they are levelling with people with little clinical experience.

Yeah, they don't. They basically grade you on how "nice" of a person you seem to be. <shrug>

 

[Orbo]

Agreed. OP - it's much easier to show sincere empathy when you're an MS3, and actually have a sick patient in front of you....as opposed to a mediocre actor. It's easier to feel genuinely sorry for someone who actually DOES have cancer, instead of someone that you know is acting.

Even harder when they're bitching about the common cold and you gotta squeeze out that last drop of humanity in you to eke out the "that must make life difficult for you...how does it affect your work and daily activities?"

Just thinking about it makes me squirm.

 

[smq123]

Even harder when they're bitching about the common cold and you gotta squeeze out that last drop of humanity in you to eke out the "that must make life difficult for you...how does it affect your work and daily activities?"

The worst is when YOU're really sick, and the patients are coming in for a common cold or allergies or post-nasal drip or something.

 

[45408]

Just do the fake empathy ****. If they have a headache, ask if they want the lights turned down, etc. Stuff like "that must be difficult" or "how are you coping with that" or "yeah, you seem to be in a lot of pain" (that one's great if they act completely normal, but the pain is an 8/10), remember PEARLS.


Don't be ashamed to say stuff you'd never actually say in real life, they're just waiting for you to say something so that they can check off a box. The fake patients always seem to be pretty weird people anyway, it's tough to relate to them regardless, so just be shameless with faking empathy.

No kidding. I had an actor playing a patient with borderline PD who had just slashed her wrists. I'm not convinced that she was acting - it looked like it was coming way too naturally. They are often a bit odd.

Anyways, I've been told I haven't been empathetic enough, but come on, I know you're not in pain, so it's hard for me to fake it.

 

[45408]

Agreed. OP - it's much easier to show sincere empathy when you're an MS3, and actually have a sick patient in front of you....as opposed to a mediocre actor. It's easier to feel genuinely sorry for someone who actually DOES have cancer, instead of someone that you know is acting.

Exactly. It's even worse when you've seen people die or told them they were about to die, and you know how that feels, and then you have to fake it to someone in a pretend hospital room.

 

[45408]

The worst is when YOU're really sick, and the patients are coming in for a common cold or allergies or post-nasal drip or something.

haha, I heard a great story about that. Some patient came sniveling into the ER with a mild sunburn, complaining about the horrible pain. One of the nurses came to one of the residents and said "Here, this should be a good one for you."

Resident went in, and the pt was looking at the floor, tearfully saying "Oh, it hurts so bad, this sunburn is - oh." The pt looked at the resident, who was fire-engine red from a horrible sunburn, and realized that the resident would not have much sympathy. Panda Bear has talked about how he's had patients who weren't nearly as sick as he was, but he had to keep on trucking.

 

[Doublecortin]

The only places you can touch non-clinically is to shake hands and perhaps a hand on the shoulder.

Simulated patients are either really ****ty actors who do it as a job to make money, or people who had bad patient experiences and want to take it out on the medical community. It's a tough crowd either way.

I'd advise thinking about someone you actually know who actually has a condition and act as if you were talking to them about their problem.

I'm assuming you busted out the Oscar performance for med school - who didn't. Dust off the statue and get to work.

exactly! I had one of those old *#ckers who just completely trashed me and my classmates after the interview and PE. He even told one girl that she shouldn't be a doctor 😡. I felt like a lot of his comments were just trying to put us down, like you did this terribly and you obviously don't know how to do that, rather than provide constructive feedback

I honestly believe all this standardized patient crap is a bunch of bull. You either have empathy or you don't. You can fake it if someone's watching you but once you are on your own, you just go back to being old you.

I think this is a fairly recent invention in the medical education, maybe 10-15 yrs old. Old school docs didn't have any of this SP stuff and most turned out great doctors.