A Lesson in Compassion

By Anastasia Toufexis

Ellen Weiss can hardly see. David Schmitt can barely hear. Together, the elderly woman, who suffers from diabetes, congestive heart failure and arthritis, and the widower, who is recovering from a hip fracture, slowly shift through the halls of Hunterdon Medical Center in Flemington, N.J. Typical victims of aging's cruelest blows? Not really. Weiss is actually a resident in family practice, age 30, and Schmitt a medical student, 26. They have been assigned roles, ages and infirmities as an innovative part of their medical training.

Introduced in only a few medical centers so far, such role playing is designed to expose doctors to the anguish endured by the infirm. It is just one of several techniques being tried at U.S. medical schools and hospitals in an attempt to deal with the most universal complaint about doctors: lack of compassion. "Residents are usually young, healthy, privileged," says Dr. Stephen Brunton of Long Beach Memorial Medical Center in Long Beach, Calif. "They've not really had a chance to understand what patients go though."

Role-playing programs give them a crash course. At Hunterdon, students' faces are instantly aged with cornstarch and makeup. Next the disabilities are laid on: yellow goggles smeared with Vaseline distort vision, wax plugs dampen hearing, gloves and splints cripple fingers, and peas inside shoes impair walking. Then the ersatz invalids are asked to perform common tasks: purchasing medication at the pharmacy, undressing for X rays, filling out a Medicare form and, most humiliating, using the bathroom.

At Long Beach, new residents in family practice assume fabricated maladies and check into the hospital for an overnight stay -- incognito. The staff treats them as they would any other patient, even sending them a bill. The entire entering class of medical students at the Uniformed Services University of the Health Sciences in Bethesda, Md., are issued bedpans and told to use them. They spend part of the first day of school as hobbled patients. A few male students are even subjected to an indignity familiar to women: waiting in the stirrups for a doctor to arrive.

Instant patients start out peppy and joking. "But by the end of a few hours, most say, 'I'm exhausted,' " observes nurse Linda Bryant at Hunterdon. Schmitt discovered that "a major accomplishment was doing up my collar." And, to his surprise, "I wound up resenting physicians who didn't realize how much medication would cost and how hard it was to go and pick it up." Weiss also had an epiphany: "I realized how little I talk to patients. I might ask them about chest pains but not 'Can you get dressed, eat O.K., take your medicine?' " At Long Beach, Jeffrey Ortiz thought he was in for a quiet rest when he was sent to the intensive care unit, suffering from "chest pains." Instead he spent a sleepless night: "People were coming in to do labs, the man in the next bed was groaning, and the heart monitor was bleeping. It was noisy and scary."

Any patient could have told him so, but many educators believe the direct experience of such miseries will leave an enduring sense of sympathy. Doctors have long defended taking a cool, dispassionate approach to patient care, arguing that it helps preserve objective judgment and protect against burnout. But critics disagree. "By concentrating on symptoms and lab data, we ignore a wealth of information that can affect patients' well-being," observes Dr. Simon Auster at the Uniformed Services medical school. Moreover, he says, "it takes less energy to get close to a patient than to maintain a distance." Auster warns, however, that caring should not be confused with wallowing in soppy feelings with patients or adopting an appealing bedside manner. "That's superficial charm," he declares, as opposed to the more difficult task of grappling with the painful emotional issues in medicine.

To lure more caring individuals to the field, schools are seeking older students as well as non-science majors. Reformers are also revising the curriculum to place more emphasis on how to relate to patients. Some schools have engaged actors to portray patients -- some of them ornery or withdrawn -- whom students must then interview and counsel. At Duke University's medical school in North Carolina, Melanie Wellington had a tough time with "Tom Brown," a black man in his 50s, whose dietary habits were contributing to high blood pressure. "Brown" said he didn't want to be treated with drugs because medication had ruined his brother's sex life. Says Wellington: "The biggest problem was my own discomfort," particularly when it came to asking him about his sexual history and possible drug abuse, which drew hostile responses. "Now I preface my interviews with, 'These are questions we ask everyone. We need the answers to take the best care of you.' "

Such educational experiments are not a panacea, but already they are yielding some symptomatic relief for patients. At Long Beach, the residents' experiences as patients-for-a-day have prompted administrators to accelerate the hospital's admissions process: it now takes 15 minutes or less. Other results are harder to measure but just as significant. Robert Stambaugh admits that he felt "self-conscious and silly" during his brief stint impersonating a patient at Uniformed Services. But two years later, he drew on the experience to summon up sympathy for an obstreperous patient whose brain had been injured in a car accident. "He'd throw bedpans, pull out catheters and verbally abuse everyone," Stambaugh recalls. As the student doctor who had to repeatedly replace the catheters, he was tempted to blow his own top. "On reflection, though," he says, "I recognized that the patient was scared to death, confused and had lost a great deal of his dignity. That was what made me able to deal with him."