"Chuck" (not his real name) knows a thing or two about physician-patient encounters.
He's not a doctor, but rather an actor and a "professional patient" as well as a real-life patient.
Chuck is in his 60s. Among his gigs is working in med schools where he is "treated" by medical students and other professionals in training.
Just as when he appears in a play, Chuck gets a scenario for his mini-dramas in the exam room. He is given a list of symptoms and limitations -- such as restricted ability to move a leg or slurred speech -- to build his character. "These are things you are supposed to do to give [trainees] cues. You don't want to misdirect them into something," says Chuck.
Professional patients give future medical professionals a dose of reality in dealing with patients without the risk of harm. They are the training wheels before the Big Show of actual practice.
Chuck has had a wide range of scenarios. He has presented to trainees as having had a stroke, Parkinson's disease, diabetes, high blood pressure and other conditions.
As they say in the acting game, there are no small parts, just small actors. Likewise, there are no small diseases nor small patients.
Sounding a note from the lead in Shakespeare's "Merchant of Venice," Chuck says his philosophy in dealing with trainees is to show "they're really dealing with human beings and human beings have feelings."
To paraphrase the Bard: "I am a patient. Hath not a patient eyes? Hath not a patient hands, organs, dimensions, senses, affections, passions? Fed with the same food, hurt with the same weapons, subject to the same diseases, healed by the same means, warmed and cooled by the same winter and summer as a physician is? If you prick us, do we not bleed?"
Chuck sometimes dons a patient's gown. He hasn't had to die in an exam room. But he will get emotional and say, "Am I ever going to feel better?" He is pleased to see how the students respond to comfort him.
He says students sometimes struggle, but they generally are an empathetic lot. "They must be selected for that," he observes.
Chuck says that experienced instructors guide the newbies in the experience and correct them as needed to teach them how to relate to patients: "The instructors are really good."
The actor-patients even grade the trainees on their "interpersonal relationship," taking into account their bedside manner, their empathy and their therapeutic gaze.
I complained in this blog in February about how I am finding that some physicians I see -- not all -- seem focused on their computer screen as they fill out the electronic medical record and do not seem to engage with me at all. These doctors are losing the art of the therapeutic gaze as they focus on the EMR on their computer screens.
I heard from a number of readers who agreed. This included doctors who complained about seeing their own physicians look at the screen and not at them. Some doctors placed the blame for this behavior on requirements to use the EMR and check the boxes.
Chuck has observed patient neglect in his real-world encounters with orthopedic surgeons, ophthalmologists and others.
He told me about consulting with an orthopod. He said the surgeon said hello and never never looked him the eye again.
"The guy is there dictating his notes into the computer and not looking at me, but looking at the computer. I don't know why he had to do that. He's dictating into the computer. Or maybe he's doing stuff on the computer plus he's dictating. I don't know what he's doing. Facebook? Email?
"He was just asking me questions over his shoulder. He would ask questions and I would answer and then he would dictate into the machine, 'The patient says ... ' I became the patient. He never looked at me. And he said, 'I think maybe you should get that replaced. Okay. So we'll set up something.'"
Chuck gave this doctor an "F" and went to see another orthopod.
In the few years he has been a professional patient, he has observed that "the laptop has become much more of a presence in the physician-patient interaction."
On occasion, he sees the same students again after they have had a year of further training. "In the beginning, they have a hard time interacting with the new technical equipment and still making eye contact with the patient." But later on, he says these soon-to-be doctors have figured out how to incorporate the laptop and the EMR with eye contact for a more satisfying patient experience.
So old docs listen up and smell the coffee, buster, as my old colleague "Ann Landers" would've put it. Learn from the newbies. Keep your gaze on the patient -- at least between stops for entering data on the computer.
In the end, the eyes have it.
Howard Wolinsky is a veteran medical writer who has been writing on 51˶ for the last 2 years about his own personal struggles with prostate cancer, his metabolic health, and the evolving healthcare system. Click here to read earlier installments. He lives in Chicago.