Helping doctors with bedside manner

By Matt Thompson
Producer, The Simulated Patient

Richard was given only 6 weeks to live

Every time Richard Tate visited the Royal Marsden Hospital the news got worse.

"I went to see the specialist and he told me there was a shadow on the X-ray, on the lung.

"I definitely had lung cancer and it had metastasised and spread to the liver. I also had prostate cancer."

Richard was given only six weeks to live. But that was 10 years ago and it was not true, it was in a script.

Richard is a role-playing actor brought in to help train doctors how to break bad news.

In the old days, doctors learned communication skills on the job by watching senior doctors handling difficult situations and copying them.

It was a haphazard process of osmosis. When the European Working Time Directive came in, it suddenly became illegal for doctors to work incredibly long hours.

This was a good thing but it meant that, instead of seeing one doctor, a patient might typically be treated by a whole team, each handing over to another.

Skills

In GPs' surgeries, the time for consultation seems to drop each decade - 10 minutes, 8 minutes, 5 minutes.

The GMC recognised something had to change and, in the early 1990s, it brought out an influential paper called "Tomorrow's Doctors", which recommended communication skills should be taught explicitly throughout all medical schools.

Bedside manner became official.

Phil Harrison is a "simulated patient" who, during the gruelling medical exams, works in a vast stadium in Sheffield filled with hundreds of cubicles, each with an actor, each with a different make-believe disease.

The medical students are watched to see if they can elicit the information from the actors which will lead to a correct diagnosis.

Mr Harrison says: "The students are taught noddies (to nod), grunting (encouraging verbal grunts) and flashing (where they flash their eyes in a twinkly manner.)

You realise they've been so busy writing things down they have forgotten to listen Phil Harrison

"Sometimes you can see the technique coming through.

"A classic is when they take your history and they say, 'How's your parents?' and you reply, 'My dad's OK but my mum died of horrible cancer yesterday,' and they say, 'Great,' and you realise they've been so busy writing things down they have forgotten to listen."

The students are not taught to perform but, by careful analysis of what they are good at, hopefully they can develop good habits.

Mr Harrison says: "It's like a mirror and, by watching themselves through comments by fellow students, they can see what they are doing right or wrong."

One day Richard Tate felt poorly and visited his GP. He had leukaemia, for real. He did not react much, he did not cry, and only when he got home did it hit him.

He is now in remission and playing Corporal Jones on tour in Dad's Army.

But his experience altered the way he portrays dying patients: "I don't go in for the histrionics now, award-winning Baftas. It's much more low-key."

He felt that being a simulated patient helped him be a real patient and present a concise history of his symptoms.

Richard Tate has played in the West End of London, been in Disney's Beauty And The Beast and sung in the Palladium.

But he feels his most moving acting has been in the Royal Marsden in front of an audience of medical students, playing a role he has unfortunately now had direct experience of - a sick man.

The Simulated Patient will be broadcast on Monday 24 March at 2100 GMT on BBC Radio 4.