Name: Melissa Daum (the au pronounced like ou in ouch)
Occupation: Standardized Patient
Years in Baltimore: 8
Melissa Daum plays many roles: she’s a grad student, yoga teacher, therapist-in-training, seamstress, and mural painter, but perhaps her most intriguing part-time job is as “Standardized Patient,” for the Johns Hopkins School of Medicine. In other words, the 28-year-old MICA graduate pretends to be a patient for trainee doctors, and not all of them know she’s acting.
According to Hopkins, a Standardized Patient is “a person carefully recruited and trained to take on the characteristics of a real patient, thereby affording the student an opportunity to learn and to be evaluated on learned skills in a simulated clinical environment.” Melissa, who’s currently completing a master’s in counseling at Pacifica Graduate Institute, won the role by passing an audition at the School of Medicine’s Simulation Center, where she competed for the job with professional actors. “They brought along headshots and resumes, but that’s not what the medical school needs,” she explained. “They need people who can be pretty real about it, who don’t turn it into a big performance.”
Beyond her relaxed attitude, Melissa has another advantage: She’s sophisticated but looks younger than her age, which means she can represent a wide range of characters from surly teenagers to overwrought moms. “One week I might be, say, a student who’s experimenting with drugs, and the next week I might be a 15-year-old girl who’s come down with a rash after a trip to the petting zoo. I get to wear my own clothes, but we’re supposed to dress the part, so if I’m playing a married woman, for example, I’m supposed to wear a wedding ring.” She’s given a case history peppered with details—some vital clues, others red herrings—but the facts can only be drawn out by the right kinds of questions, asked in a suitable context. It’s a way of helping young doctors practice their history-taking skills, their communication facility, and their all-important bedside manners.
The work doesn’t pay much—$17 an hour plus parking—but there are added benefits, like use of the Hopkins library and the chance to learn about the symptoms of different diseases and the stress impact they have. On top of that, it’s a lot of fun. “It satisfies my theater itch,” says Melissa, who worked as Elton John’s wardrobe mistress when he performed in Baltimore last March–and played lead in all of her high school productions. “There are these rows of doctors offices in the Simulation Center. Sometimes I go from room to room as a patient, and sometimes the doctor comes in to see me, surrounded by a group of medical students.”
She often works with the same male actor playing the wife in a married couple; they fit together well, and, like the stars of a sitcom, have developed a pattern of banter (though improvisation, they’re told, should be kept to a minimum). Recently, the pair took the stage at a pediatric dermatology conference, where they were asked to play the part of every doctor’s nightmare—entitled, wealthy parents, both attorneys, who think they know what’s best for their ailing kid. “I really got into it,” laughs Melissa. “I was looking up medical facts on my iPhone and telling them I thought my child’s condition was an embarrassment to the family. When I get into a character like that, I’ll start thinking about how that person will walk into the room and how she’ll put down her purse.”
But it’s not always easy. “You can’t be shy,” she says. “If you have to play a person who’s really depressed, or in pain, it can be a very uncomfortable situation, emotionally. You can’t meet the doctor’s eyes, you can’t smile at them. As medical students, they want to treat the symptoms of a disorder, but they’re dealing with a complex person, and that can be sometimes unpleasant.”
During her work as a Standardized Patient, Melissa has learned that, as medical students get further along in their studies, their people skills tend to get worse. “As they start to specialize, they get more interested in the technicalities,” she points out. “They want to try out new equipment and discover the pathology. They forget that they’re dealing with a real person with complex feelings. They tend to back away from emotions.”
After the simulation is over, she gets to wear headphones and listen in to the doctors’ critique of the students’ performance. She also listens to the students talk about the person she was portraying, as they attempt, as a group, to make sense of who and what they’re dealing with. Melissa gets to give feedback, too, which is where her therapy training comes in useful. She has to let the doctors know if they seemed awkward, nervous, or rigid, and whether she sensed them backing away from scary emotions.
As a Standardized Patient, Melissa’s learned a lot about medical training and how the young doctor’s mind develops. She’s learned something else, too. “Once I had to be a patient having my eyes examined,” she recalls, “and suddenly there was this whole group of students wanting to look down the ophthalmoscope. They kept sending their friends to see. I asked them what was so interesting, and they said it was the first time they’d seen eyes that were exactly like the ones in the anatomy manual. They said I had ‘textbook retinas.’”