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DIAGNOSIS THEATER; THE CAREACTORS TROUPE HELPS MEDICAL PROFESSIONALS HONE THEIR BEDSIDE CRAFT

By: Evan Henerson, Staff Writer, The Daily News of Los Angeles January 21, 2002 Monday

Dr. Norma Waver is having a bad day.< She began her emergency room shift by fumbling through an encounter with a lesbian couple seeking assurances that both partners could be present at the delivery of their baby. Next, Dr. Waver displayed obvious discomfort over a Hmong girl's request to keep the placenta following the birth of her baby. Finally, when the well-meaning but somewhat inflexible physician met a Somali woman who underwent ritual circumcision, she lost control and got into a shouting match with a nurse.

This scenario is "Beyond Obstetrics" a scripted performance by the CareActors, a live theater group designed to help educate doctors, staff and other employees at Kaiser Permanente. Dr. Waver is actually Silvie Zamora, an actress who has worked for Disney and done several plays in the San Diego area. Every person in the "Beyond Obstetrics" presentation is an actor, some with auditions or performances later in the evening. When they play doctor for medical education, actors become "standardized patients."

Once the program is over, the actors mingle with the participants of the seminar, titled "Toward Culturally Responsive Care." Physicians of all specialities, not just obstetrics and gynecology, talk about some of the issues and behavior depicted by the CareActors. From Dr. Waver's missteps, real physicians learn a thing or two about bedside manner.

The actors benefit as well.

"It's such a great actor workout," says Zamora. "You can't lie. If you don't know what you're doing, it's painfully obvious to everybody."

Healthy reviews

Standardized patients (or SPs) are often professional actors who are paid for their performance (usually from $12 to $25 an hour) and enjoy the scheduling flexibility the work allows. An actor might earn more waiting tables, but he won't exactly be practicing his craft, say SP participants.

Dr. Nancy Jasso, chief of dermatology at Kaiser Permanente, Panorama City, watched Zamora and her fellow CareActors perform at the "Toward Culturally Responsive Care" seminar in Pasadena. As always, she was impressed with their work and pleased that Kaiser has such a program in house.

"I make it a point to attend as many of these programs as I can," said Jasso. "Providing care is more than just curing a disease."

Medical schools throughout the country have standardized patient programs. Not all use professional actors, but SP program directors say Los Angeles, with its huge acting pool, can be somewhat selective.

"If you run a truck up on the sidewalk in L.A., you'll hit an actor," jokes Elizabeth O'Gara, director of the standardized patient program at the UCLA School of Medicine. She should know. UCLA's program sifts through some 400 head shots each year and has a pool of 100 SPs who do regular work.

Actors around the city play breast cancer sufferers, stroke victims, drug addicts and whomever else a scripted scenario calls for. In addition to acting out scenes for seminars and conferences, standardized patients also perform mock physical examinations and assessments for medical students so the budding doctors can work out their patient skills without the fear that a wrong move could get them fired or sued.

The CareActors program has taken its performers all over California and out of state. A stable of 21 actors can perform more than 40 scenarios on topics ranging from stress management to workplace trauma. A full-time writer can craft a new play or scene to fit a given need.

"It's like a dress rehearsal for life," says Lisa Beezley-Lippman, CareActors' program director. "We dramatized a real situation for a conference for 500 to 600 physicians, dealing with physician wellness, encouraging them to take better care of themselves and having them take a look at why they became doctors in the first place.

"All of the programs we do are really about improving relationships," she continues. "We've had people in tears. Doctors who attend our stress management programs have broken down and said, 'That's why my marriage failed.' It breaks down barriers and forces you to feel things, usually in a safe environment."

Fitting the cast

In the four years she has been running the program, Beezley-Lippman has increased the acting pool from a core group of five actors to 21, with regular recruiting - through the film and theater trade magazine Backstage West - to bring in new talent. Beezley-Lippman is a member of the Colony Theatre Company in Burbank, though she admits her full-time job as program administrator for Kaiser has made squeezing in acting work more challenging.

Not that she's complaining. Developing programs and training actors for this kind of work is far more involved than, say, the histrionics that Cosmo Kramer went through when he earned extra money playing a gonorrhea sufferer on a memorable episode of "Seinfeld."

SPs need to be able to act convincingly and improvise, say program administrators. Some are also called on to give feedback to the doctors and medical students with whom they've played a scene.                                                                       

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The Daily News of Los Angeles January 21, 2002 Monday, Valley Edition

"I'm not looking for people who can make me laugh or cry," says Beezley-Lippman. "I'm looking for realistic portrayals with very interesting choices. This is not very glamorous. I'm looking for people with a genuine interest in wanting to provide good service."

Like many actors who do SP work, David Gallagher of Studio City believes his performances are serving a purpose beyond earning a paycheck or getting a resume credit.

"We've all had doctors who don't care and it's obvious they're just going through the motions," said Gallagher. "And some students are so scientific they don't have great people skills. This is the first time they have to deal with people. Really it's all about bedside manner. That's why we're here."

Dress rehearsal

On a recent Tuesday in a classroom near the UCLA campus, Gallagher played a 32-year-old gay man who didn't especially trust doctors. But the character needed to have a physical exam and a tuberculosis screening test for a new job.

With her classmates watching, first-year medical student Jamie McInturff took Gallagher's medical history, stopping the action periodically when the line of questioning became difficult or uncomfortable.

Gallagher's character is a smoker and a nonmonogamous gay man who doesn't always practice safe sex, meaning the physician conducting the interview had to offer medical advice without imposing a value judgment. Gallagher has a script to follow, but he can disclose information or hold back depending upon how comfortable the questioner makes him feel. Two weeks later, Gallagher would return to be counseled by his "doctor" on the smoking.

McInturff wasn't alone in the hot seat. In several classrooms in the same building, O'Gara's SPs were playing the same role opposite other first-year medical students.

"When we did this before, we would bring in actual patients and there was no way to stop and say, 'Now what do I do?' " said Dr. Susan Stangl, co-director of UCLA's first-year doctoring course. "The patients we tended to get were often people who had an agenda, and they'd say, 'I want to do this because I want to lecture medical students about what I think doctors should know.' "

Added Stangl: "Taking a sexual history is really embarrassing for them most of the time, but we have to prepare them and talk about it. Giving bad news the first few times is tough. This gives the students the opportunity to all be in the same situation so they've all experienced the same thing instead of hit or miss. I think those are the real advantages." EDITOR-NOTE: HEALTH Cover story GRAPHIC: Photo: (1 -- cover -- color) Playing doctor Professional actors practice their craft while helping medical students, physicians improve their skills (2 -- 3) CareActors members Kayo Takahata, left, Rena Heinrich and Silvie Zamora, above, perform a vignette about chilidbirth at a medical seminar in Pasadena. At right, a UCLA medical student questions a patient played by actor David Gallagher. Charlotte Schmid-Maybach/Staff Photographer (4) At a seminar in Pasadena, Silvie Zamora, left, Carla Vega, Kisha Palmer (lying down) and Erica Ortega run through "A Big Baby Is On Its Way" from the CareActors' repertoire. Gus Ruelas/Staff Photographer