  
"Standardized patients" help physicians improve communication about HIV
Last Updated: 2001-04-11 18:05:43 EDT (Reuters Health)
By Steven Reinberg
WESTPORT, CT (Reuters Health) - "Standardized patients," trained to take on the role of patients at risk for HIV, help physicians improve their patient communication skills by providing feedback to the physician immediately after an office consultation.
"It is very difficult to change certain physician practice behaviors, especially communicating about difficult-to-talk-about topics, such as HIV," Dr. Ronald M. Epstein, from the University of Rochester School of Medicine, New York, told Reuters Health.
To try to modify physician behavior, Dr. Epstein and colleagues sent standarized patients into the offices of 24 primary care physicians as if they were real patients at risk for HIV. "After the visit the physician received feedback from the standarized patient about how well the physician communicated, and several months later the physicians were revisited to see if their skills had improved," Dr. Epstein explained.
"Those physicians who chose to be in the study were pleasantly surprised," he added. "They thought that the standardized patients were very realistic, and even in the cases when they knew they were talking with a standarized patient, they quickly forgot and fell back into their usual patterns of communicating."
"The feedback was confidential, convenient, and usually on the mark," Dr. Epstein continued. "Physicians reported that they had learned from the encounter and altered their practices."
The cost of training standarized patients becomes more cost-effective the more offices they go to, Dr. Epstein said. Training costs about $200 to $400, and if physicians can get CME credits for participating in the program, the $75 fee for the visit is actually very modest, he pointed out. His team's report appears in the March issue of the Journal of General Internal Medicine.
This kind of educational intervention is easily translated into many other areas, Dr. Epstein added, such as talking about domestic violence, end-of-life care, "indeed, all of those issues that physicians do not tend to talk about as openly as they wish they could."
"Many physicians find talking about these subjects with patients uncomfortable," he said. "They think that they may be prying, or they feel that patients would object to their asking such questions. Paradoxically, patients say that they expect physicians to initiate these discussions.
"What tends to happen is that the physician is afraid to initiate the conversation for fear of offending the patient and the patient is waiting for the physician to provide an entrée. Because of that paradox these discussions tend not to happen," Dr. Epstein pointed out.
J Gen Intern Med 2001;16:176-180.
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