simulated patient – The HUMAGINARIUM Gazette

Doctors learn from their experience with patients. As if you didn’t know. It starts by observing and assisting other practitioners. It expands with supervised diagnosis and treatment. It peaks in autonomous encounters with patients over the entire course of a medical career.

Some of those encounters with patients are routine. Many are unique, exploratory, to some extent baffling. A doctor in those thorny encounters is an investigator, a clue finder, a person who doesn’t know but needs to find out. The patient is ideally there to help. A patient in those encounters is a witness, a fellow pathfinder and problem-solver, maybe even a coach.

I don’t know the proportion of medical education that is face-to-face with patients, but it’s a safe bet that learning from practical experience with patients far exceeds learning that occurs in lecture halls and libraries. Learning with patients is so valuable that it’s been boilerplated in technologies known as a simulated patient and a virtual patient.

The simulated (aka standardized) patient emerged in medical schools during the 1960s, around the time that healthcare started morphing into the wondrous industrial process that we have today. A simulated patient is an improvisational actor (professional or amateur) who performs the role of a real patient with certain knotty health issues.

The actor may have personal experience as a patient with the issues that are simulated, but is also well prepared to make a contrived performance seem real. Like audience members called up to the stage in a comedy club, doctors role-play diagnosis and treatment of the simulated patient.

And it works! So well that role-plays with simulated patients are required for getting a medical license in the United States. Doctors must play to practice. In addition to sharpening clinical skills, the role-play helps doctors improve their social and communication skills and polish their comportment for awkward or embarrassing moments in the office or clinic.

The downside with simulated patients is cost. The simulations are expensive to run, even for an industry that hemorrhages billions in carefree ways. Hence the introduction, starting in the 1990s, of the more economical and scalable virtual patient.

A virtual patient is a digital replicant, like a special-effects monster in a movie. Just kidding, the virtual patient is not like a monster in a movie, but like an avatar in a video game. The avatar is programmed to have health and other issues that must be recognized, understood and treated by the real doctor who plays with it.

The virtual patient is a computer simulation, unlike a live simulated patient, but the purpose is the same: learning medicine by means of role-play. A virtual patient is endlessly replayable and easily modified to simulate different clinical scenarios and produce different outcomes. Virtual patients are much less expensive to run than simulated patients, much more accessible, convenient and versatile to use, and may be just as capable of increasing medical competence.

Which brings me to the question I’m here to ask. If simulated and virtual patients are so good at increasing the medical competence of doctors, why haven’t simulated and virtual doctors been used to increase the health competence of patients? There are one million doctors in the United States receiving the benefits of this lavish educational technology. There are over 300 million patients in the United States who don’t have a clue.

Why not offer this powerful, effective educational technology to patients? Wrong question, because there isn’t a good reason. Better to ask what for, and when.

I call virtual doctors robodocs, which I am entitled to do because I invented them. Before you came to this blog, you probably never heard of simulated or virtual doctors, so don’t argue. We can call them robodocs from now on.

On the other hand… one sec… here it comes… Robodoc™. Now I can charge you to use the term! That would make me feel more like a medical device or drug maker. (Pass the Milk of Magnesia, please.)

What would patients do with a robodoc if one existed for them? They would role-play being a patient to learn how it’s done. They would learn simple things, like how to participate in their medical treatment, how to discuss their condition and needs with a doctor, how to seek the right care in the labyrinthine health marketplace, how to pay as little as possible for care that is needed, how to avoid and prevent the care that is not wanted.

Simple things that must be learned from experience. There is no better way. Doctors know that and so should you.

I gave a name to patient learning from experience — Constructive Health Competence™ — and Humaginarium is building video game simulations to promote it. Video games for adults with chronic illness who depend on the medical industrial complex much more than others have to.

And yes, robodocs will be present in our video games. Helping real patients find their way.

Robodocs are virtual doctors that make role-play for patients feasible, both technically and economically. Playing with them lets patients safely practice their performances in the doctor’s office, lab, ER, ambulance, clinic, hospital and assisted care facility where the gold-plated meters are running and ordinary life and well-being are on the line.

Please don’t say that it can’t work. Simulated and virtual patients are already working for a million doctors including yours. Don’t say that it won’t work. Entertaining video game sims are already working for hundreds of millions of consumers including your coworkers, friends and family.

Instead ask what difference we can make if it does work. The answers are pretty straightforward: happier, healthier patients and fewer, smaller medical bills.

These are fruits of patient empowerment that is no longer the first priority of providers, payers and candlestick makers. To hell with that, let’s get it on.