[tri-med] FYI - Bedside Manner

http://www.cnn.com/2002/HEALTH/07/25/bedside.manner.ap/index.html

PHILADELPHIA (AP) -- Bedside manner is a skill many patients say is lacking
in modern medicine, but a test program calls on medical students to "play
doctor" with pretend patients to show how well they listen and talk to
people in their care.

The board in charge of the national licensing exam for doctors wants to make
the handling of patients part of the exam.

So far, the bedside manner test is being tried out as a pilot project at
three Philadelphia medical schools: the University of Pennsylvania, Temple
University and Thomas Jefferson University.

Other cities are likely to follow, beginning with Atlanta this fall.

If all goes well, the National Board of Medical Examiners, which administers
the licensing exam, hopes to make the clinical skills test a requirement for
a medical license starting in 2004.

"The cost of miscommunication that occurs in practice is far greater to the
physician and the public than if you do something proactively," said Dr.
Peter V. Scoles, senior vice president of the medical examiners board.

"This will give the country a common standard and will afford some added
protection to the public," he said.

However, the American Medical Association and other groups say the hefty
price tag for a national clinical skills test -- around $1,000 plus travel
expenses to the Philadelphia testing site -- is too heavy a burden. Medical
students are already cash-strapped, they say, often carrying an average of
$100,000 in debt by the time

they graduate.

The AMA is calling on the board to hold off making the test a requirement
unless its effectiveness is proven and published in a peer-reviewed medical
journal, and until the cost comes down.

"We've already seen a drop in applications to medical schools in the United
States and increasing costs in this way will, in fact, worsen that problem,"
said David Rosman, an AMA Trustee and a fourth-year medical student at the
University of Massachusetts.

Medical schools already have their own clinical skills tests but Scoles says
the new test would create a national standard. A clinical skills assessment
used to be required for a medical license. But it was dropped in 1964 amid
concerns about its reliability.

However, graduates of foreign medical schools who seek to practice in this
country are required to take the test.

"We're not objecting to the test itself but the financing issues are very
worrisome; there's no way to do this test on the cheap, unfortunately," said
Dr. Jordan Cohen, president of the Association of American Medical Colleges,
which also wants the test put on hold until funding alternatives can be
found.

The test takes about six hours to complete and consists of 10 to 12
15-minute encounters with so-called standardized patients -- some are
trained actors, others are not. Each is given an illness to act out,
explaining his or her symptoms to the doctor and knowing when to say "ouch"
during the examination.

It's up to the doctor to ask the right questions and properly analyze the
symptoms, then make a correct diagnosis. The actor/patients can be
recalcitrant or uncommunicative or overzealous -- sometimes all three.

Proctors behind two-way mirrors watch the exchange between doctor and
pretend-patient and video cameras record the interactions for grading and
training purposes.

The doctor is given seven minutes to report the findings, which are later
graded by senior physicians. The "patient" also assesses the visit.

Scoles says the new exam is a reliable guidepost to a medical student's
communication skills -- something a pen-and-paper test is unable to measure.
The Board of Medical Examiners expects that up to 2 percent of students will
fail the exam on repeated attempts, though there's no cut-off to the number
of times it can be retaken.

"According to some data, 85 percent of medical malpractice cases are based
on communication issues," Scoles said. "It is expensive to do, but evidence
points to the need for a test like this."

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