Follow up to “Japan is Safety Country”.
Simulated Patient
Around 20 years ago I was trained by a doctor visiting from the States who was in charge of her med school’s Simulated Patient (SP) program in the basics of being a SP for the purpose of training medical students in Japan in how to diagnose without relying on tests, especially their beloved CBC.
I have since been trained by various MDs from both the States and Japan in various medical conditions. In these I learned the typical experiences of those suffering from these conditions and what information the doctors must get from the patient while being reminded that as a SP, I am not to divulge it unless asked.
With this training and subsequent experience as both a SP and tester of med students I have been invited to participate in workshops for medical students and or those who teach them around not only Tokyo but also across the country. In all of this, the medical doctors I have worked with or under have stressed several points, the most relevant here is that whenever pain is concerned and especially if it is the Chief Complaint, the MD MUST get the following information form the patient; When did it start? What were you doing when it started? Does anything make it better or worse? What kind of pain is it? Where exactly is the pain? Does it spread or travel anywhere? On a scale of 1-10, 10 being the most pain you can imagine, who painful is/was it? Does anything seem to bring it on? Do you have it at specific times of the day or after certain activities? How long does it usually last for?
We were asked not a single one of these and when I attempted to tell them without being asked, not a SP in this situation, I was shut down.
As medical students we were taught that a good history would provide a diagnosis in 80% patients - this advice has served me well in an age when a physical examination bloodwork and a PET scan 😳
insane that those common sense questions are not asked. I suppose too many patients might then think and perhaps tie it to medical procedures they had had before. If the point is not to get the patient better, what is the point?