A role to die for
You’ll never see their names on a movie billboard, but James Cook University’s volunteer patients are star performers for medical students keen to translate textbook knowledge into practice and develop the crucial inter-personal skills required to become caring doctors.
The volunteers lend their bodies for physical examinations and also role play a challenging array of patients in consultation scenarios with medical students throughout the course of their studies, from Years 1–5.
“They cannot learn all they need to know from a book – that would be like trying to learn to swim by reading,” said Judy Hibbert, a volunteer patient from Ayr, near Townsville. “They need hands-on experience.”
The 62-year-old retired office worker began role playing for the University five years ago, and the diversity of her acting credits would put an Academy Award-winning actress to shame. Her repertoire ranges from a 21-year-old seeking the ‘morning after’ pill to a 75-year-old woman with osteoporosis and a broken arm.
Mrs Hibbert is also a veteran at playing patients confronting death – during training sessions with registrars in the Intensive Care Unit (ICU) at Townsville hospital. The roles are unscripted and challenge her ability to ad lib.
“We are given a scenario and three ways to play it: agree with the treatment offered by the doctor, refuse the treatment offered, or be undecided,” she said. “It’s entirely left up to the role player involved to act as they feel comfortable in that situation.”
She herself has lost three family members to cancer and draws upon their experiences to inform her performances.
“I had a niece who died at 32 from cervical cancer,” she said. “When she was sitting in hospital and they told her that unfortunately there was nothing more they could do for her, she said: ‘Well, you can’t just send me home to die.’ And I have used that quote, when I’ve been working with students at the hospital.”
Her husband, Peter, 75, has been treading the boards as a volunteer patient for more than a decade. A retired power station purchasing manager and former naval wireless operator, he once spent 11 months in a repatriation hospital, after sustaining serious leg injuries in a fall from a ship mast.
“I required extensive surgical and medical treatment, including bone grafts,” he recalled. “I consider volunteering now as an opportunity to give back a little bit of my time to the medical profession for the time they’d put into me.”
He agreed that the “close to death” scenarios were particularly draining.
“The role play sessions last for about three hours. During that time we perform for three different registrars in the ICU,” he said.
Retired small business owner, Ray Breckenridge, 74, from Townsville, once had to assume the role of a man whose grandson was in a hospital intensive care unit, following an accident that killed his parents.
“I had to weigh up whether to say ‘yes’ to turning off his life support, because he was brain dead,” Mr Breckenridge recalled. “You’ve just got to put yourself right into the role. To make it as real life as possible. I cried.”
Both male volunteers help medical students to hone their physical examination skills, by allowing themselves to be subjected to a battery of abdominal, cardio, respiratory, muscular skeletal, optical and audio tests.
Mr Hibbert even bites the bullet and volunteers for “intimate male examinations”, including rectal exams for prostate cancer, while Mr Breckenridge gives a guided tour of his cardiac surgery scars.
“I had heart bypass surgery 26 years ago,” he said. “Students immediately notice the scar down the front of my chest and ask about it. A lot of them – the younger ones – have never seen a scar from open-heart surgery, so they’re a bit intrigued. Then they spot the scar down my leg, where they’ve harvested the vein to use in the grafting.”
Being a volunteer patient does have its lighter moments. Mr Breckenridge has been called upon to play a 28-year-old pregnant woman, (“I became Rayleen, instead of Ray”) and Mr Hibbert has also dabbled in nubile cross-gender roles.
A registrar once observed that she found it difficult to engage in a terminal role play scenario with Judy Hibbert, because the volunteer patient looked too healthy to be dying of cancer.
“I told her that I have good days and bad days – this was one of my good days,” Mrs Hibbert said, tongue-in-cheek.
Volunteer patients, in general, do not play saintly, biddable invalids.
“It’s important for students to have the opportunity to interact with a diverse range of personalities,” Mr Hibbert pointed out.
His wife’s most challenging role to date was a stroke victim approaching death. “I needed to be upset, crying, confused, angry and pathetic; my mind a jumble of emotions and questions,” she said.
Mr Hibbert nominated an unresponsive patient, “away with the fairies”, as his most demanding performance.
“I found it hard to sit there and not respond to the doctor, other than with totally inane, irrelevant chatter,” he recalled. “I even had to pretend to pluck rabbits out of the air.”
When not in character, the volunteer patients actively strive to calm student nerves and build confidence.
“If you have a bit of a joke with them, it seems to settle them down a bit,” Mr Breckenridge said.
They are particularly nurturing towards the most junior students, whom Mr Breckenridge fondly refers to as “baby doctors”.
Unless it is an exam situation, Mrs Hibbert is happy to drop the odd hint to a Year 1 or 2 medical student floundering during a mock consultation. “If they’ve missed a vital clue, I may ask if there was something else they wanted to ask me …” she said.
On the other hand, an eagle-eyed student can save lives. “The year before last, during a skin examination, a student picked up two melanomas on a chap’s back,” Mr Breckenridge recalled. “If he hadn’t been a volunteer patient, he may not be here today.”
Exam time is challenging for both students and their volunteer patients.
“You are given a lot of good scenarios, but you have to be very precise and act it out the same way each and every time, for every student sitting the exam,” Mr Breckenridge said. “The pressure’s on and they’re all very nervous.”
He is always pleased to re-encounter a student he has previously assisted – and watch them sail through an exam. During his first stint as a volunteer patient, a Year 1 student struggled to wrap a blood pressure cuff around his arm. The volunteer quietly summoned a tutor to provide guidance, then allowed the student to practice on him several more times.
“Two months later, during the exam, the student absolutely flew threw it,” Mr Breckenridge said proudly. “He was tremendous. When I congratulated him, he said he wished to thank me for giving him the confidence he needed. I walked out feeling so chuffed.”
Mr Hibbert is equally touched by the gratitude of students.
“I think it’s particularly pertinent when a student will say to me, getting towards the end of the year, ‘I hope I get you in the exams’, or you’ll meet them elsewhere and they’ll say, ‘look, we really appreciate what you do for us’. Just out of the blue, without any prompting,” he said.
All three volunteers enjoy helping to shape the doctors of the future.
“They are learning the importance of handling patients gently and professionally, in order to establish trust and assist in diagnosis,” Mrs Hibbert said. “We are helping to build their confidence and experience.
“We watch them develop until graduation – and sometimes beyond. On several occasions, Peter and I have been seeking medical assistance and have come across some of our previous students. We’ve been able to laugh with them and say, ‘this feels just like a role play’.”
Dean of the College of Medicine and Dentistry at JCU, Professor Richard Murray, said the University’s volunteer patients added a vital dimension to medical training.
“The opportunity to practice physical examinations on real people is invaluable for medical students,” he said. “The volunteers also challenge students to view patients as individuals, not generic cases, and encourage them to forge respectful, empathetic relationships with those under their care.”
Professor Murray said Patient Experience Week (April 23-27, 2018) was the perfect time to recognise our volunteers.
“The week celebrates those people who have an impact on patient experience. JCU would like to thank all of our volunteers for the role they play in transforming medical students into caring doctors.”