Doctors Get Taste of Own Medicine

Cynthia Herzog recently spent 18 grueling hours in a hospital bed with patches on her eyes and no food in her stomach.

Deborah Pauer survived a sleepless night in traction.

Paul D. Chan experienced his first rectal exam. “It was uncomfortable,” Chan, 25, said later. “It’s very high on my list of humiliating things.”

It also was part of a lesson that he hopes will make him a better doctor.

In fact, all three of the “patients” were really doctors. Using phony names and feigning symptoms of various ailments, they were completing their first task as new family medicine residents at Long Beach Memorial Medical Center. The assignment: to spend a night in the hospital, viewing it in much the same manner as their future patients.

“These physicians are about to embark on lives of caring for patients,” said Dr. Stephen Brunton, head of the hospital’s residency program in family medicine. “It seems only appropriate that they should spend their first day as patients.”

The program, designed to sensitize participants to the hospital environment and thereby make them better doctors, grew out of a dramatic experience Brunton himself had more than 16 years ago when he was a medical student.

Once in a karate match, an opponent kicked him in the eye so hard that he almost lost his sight. Taken to a hospital emergency room, Brunton said he silently trembled as the attending physicians made small talk. Then, terrified of going blind, he spent a week in the hospital hanging on the outcome of each examination by the doctor responsible for determining whether the eye could be saved.

Brunton recalls that he was so emotionally distraught that each day after the physician left Brunton realized he had not heard a word the man had said.

“So much of what we do involves relating to patients,” Brunton said, “yet I was lost. It was the most profound experience of my medical education.”

Determined to impart some measure of that experience to younger doctors, Brunton four years ago began requiring first-year residents to spend a night in the hospital. Since then, he said, more than 20 have done so.

It is not always easy to pull off, the doctor said.

Assigned specific illnesses, injuries or symptoms, the doctors were coached on how to feign symptoms of their ailments even to the point of concocting convincing medical histories that include recent accidents or mishaps. Some are outfitted with paraphernalia to simulate medical conditions, such as body casts for injuries, eye patches for blindness or earplugs for hearing impairment. Then, using aliases to conceal their true identities from nurses and administrators, they are admitted to the hospital.

To avoid medical mishaps, Brunton said, attending physicians are told of the ruse.

This year’s batch of residents came in with a wide range of imagined complaints.

Chan posed as an AIDS patient named Paul Li whose symptoms included chronic fatigue, loss of appetite, headaches and blindness. Using the name Elizabeth Brown, Pauer concocted a back injury from an aerobics accident which, she claimed, was exacerbated by a cross-country drive from Ohio. And Herzog, alias Anne Borland, told hospital admissions clerks that she had fallen asleep wearing contact lenses, contracted a serious eye infection and now was experiencing abdominal pains.

Other “ailments” afflicting the seven residents who took part in this year’s charade included severe gastritis, chest pain, a broken leg from a bicycling accident, a broken arm and a serious head injury.

Like regular patients, the doctors were each put on intravenous hookups, assigned hospital diets appropriate for their conditions and restricted to their beds--sometimes without bathroom privileges--to the extent deemed necessary.

And like regular patients, they came away complaining of hospital life.

“You hear sounds,” Pauer said. “A hospital at night can be scary.”

“It was very boring,” said Jeff Ortiz, 26, who spent the night in a leg cast. “The beds were uncomfortable.”

Observed Chan: “I didn’t know what would happen next. I waited for my doctor a long time.”

Most hospital staffers said later that they had no idea the seven patients were phonies. One exception was a nurse attending Hideta Sakemi, supposedly in the hospital for severe upper abdominal pain, but actually a 33-year-old Japanese internist in the United States to study American medical practices.

Sakemi, according to his attending nurse, raised her suspicions by displaying above-average interest in his lab stats. “I told him that his white blood count was kind of low,” Beatriz Cano said, “and he wanted to know how low. I asked him if he was a medical student.”

In past years, in fact, some nurses have expressed resentment at being hoodwinked into providing hours of care for patients later revealed never to have been sick, Brunton said.

And one year, hospital spokesman Ron Yukelson said, a medical resident posing as a cocaine addict was treated badly by nurses who “took a dim view” of her addiction.

For the most part, though, those associated with the program say the hospital’s nursing staff has acted with complete professionalism. And after having the program explained to them, Brunton said, most nurses see its value.

And this year’s batch of residents declared that the experience would make them more sensitive to the needs of their patients.

“I think I’ll have more empathy,” Ortiz said. “This helped me understand that (being in the hospital) can be very frightening.”

Sakemi said that in the future he will try to give hospitalized patients more freedom by creating an atmosphere in which they can “ask for anything they want.”

And Chan said he plans to help future patients by spending a lot more time “talking to them to explain every detail” of what he does.

In real life, of course, the hospital experience often extends well beyond a patient’s actual stay in the hospital. To help bring that home, the residents received prescriptions as they were discharged the morning after their admissions--placebo pills which they were told to get from a pharmacist and ingest as directed.

At the end of a week, Brunton said, a spot check of the doctors’ pills--which in the past has consistently revealed huge lapses in their ability to follow directions--would form the basis for a lecture on getting patients to take their medicine.

The residents also will be exposed to the pain and surprise that usually accompany receipt of the bill for their hospitalization. The doctors will open their mailboxes in future weeks to discover invoices ranging from $700 to $1,000 for their night of adventure, Brunton said.

The bills won’t really have to be paid. But the message, Brunton hopes, will be clear.

“It sort of reminds me of when I was a cook,” Chan said of the training exercise. “You improve your cooking when you taste your own food.”