MANHATTAN — In one of her current roles, actress Erica Winn Ball plays a patient going to the doctor's office for some bloodwork results. The physician tells her she is HIV positive, and her script instructs her to cry on cue.
But unlike most of her acting gigs, Ball has to deliver the same performance as many as 12 times a day for an audience of one.
The mother of two works at the Icahn School of Medicine at Mount Sinai's Morchand Center as what is known in the healthcare field as a "standardized patient" or "SP."
Ball is one among 150 professional actors hired as part-time employees to help train medical students and residents in such skills as taking medical histories, conducting physical exams, and perfecting one's bedside manner — a practice that can be traced back to the University of Southern California in 1963.
"Every graduating medical school student has to go through a high-stakes, national performance-based assessment exam in order to get a license, so this is something we take very seriously," said Dr. Sondra Zabar, the director of the SP program at NYU School of Medicine in Kips Bay.
Physicians' encounters with SPs begin their very first week of medical school in late August or early September, according to Dr. Cary Blum, a former NYU medical student.
"In hindsight, it's actually pretty terrifying," he said.
SPs work from a script that sketches out their character's background, personality and condition, as well as the scenario that should unfold during a simulated doctor's appointment. When the scene ends, actors fill out checklists evaluating their physician's performance and offer in-person feedback.
"It’s rare to see what a patient really thinks, so it’s incredibly valuable feedback," Blum said.
For their services, actors get to practice their craft and collect a paycheck — at NYU, the rate is $25 an hour. Here's what three SPs shared about their time in the fake exam room and the lessons it taught them:
► Doctors are human.
Doctors-in-training arrive at medical school with their own sets of strengths and weakness, actor Franz Jones, 64, said.
"You have people who come into the room and are very loquacious, and they’ll ask every question in the world," explained the actor, a member of the original Broadway cast for the musical "Big River." "And you’ll have others who basically come into the room and want to go in the corner and say nothing."
Even after they've passed all their licensing exams, "doctors aren’t God," said Jones, who has survived prostate cancer and a stroke.
“No matter how much I may like or dislike a doctor, I will ask for a second opinion just to find out exactly what is going on, because I don’t take anyone’s word as Gospel."
The East Flatbush resident is even playing a case soon "where a man gets a colonoscopy and a mistake is made and his colon gets punctured," he said.
Actor Todd Licea has played cases for some incredibly committed student doctors at Weill Cornell Medicine, but he's willing to cut even the most distracted physicians some slack.
"Doctors are just people and they have their own problems at home and they have their own personal baggage and they see many, many patients per day," he said.
Franz Jones (far left), Todd Licea, and Erica Winn Ball (far right) all work as standardized patients at local medical schools. [Credit: Jones; Licea; Ball]
► You can always find another doctor if yours isn't meeting your needs.
Part of the job isn't just collecting a paycheck. SPs help overturn the traditional power dynamic between doctors and patients.
"There are things that make patients feel listened to and that help you communicate better and if your doctor isn’t doing that, then there’s other doctors that do do that," Zabar said. "If you’ve seen 50 doctors," or hundreds, as an SP has, "you know that, but most people only see one doctor or two doctors."
Ball, who has done voice-over work for USA Network and Lifetime, evaluates her doctors by different criteria that she did before she became an SP more than two years ago.
"You just see everything differently now, because you know what they should be doing," she said. "How are they talking to me? Are they rushing me out of the room? Are they concerned with me?”
For Licea, 51, whose acting career began with a 1996 guest role on “Bill Nye the Science Guy," the best physicians are those who commit to being mentally present during an exam.
"They seamlessly hold a conversation while they're examining me, and the conversation has such a way about it that it puts me at ease ... [and makes] me feel like I’m the only person they’re thinking about," said the Harlem resident.
Doctors like that, he added, "create space for you to want to share intimate things."
► You have just as much control over your relationship with your doctor as she does.
When Ball visits her children's pediatrician, she prepares any information the doctor might need.
"Before I go, I write down all the symptoms," she said. "You have to be able to give this doctor all the information so they can come up with a good diagnosis."
A physician can only do the kind of clinical reasoning she's trained to do with data, Zabar explained. And she can only educate patients if she knows what they do or don't understand.
Patients should ask any and all questions they have, Jones advised. "It may be small to you, but it might be important."
Licea offered a similar prescription to patients: "Rather than surrendering themselves completely to doctor, I would encourage them to always ask questions of their doctor and take responsibility for their part of the relationship."
In his words, "It's a two-way street."