Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z. I also produce and host this podcast series, Health Literacy Out Loud.

I recently met Kip Clark, who shares my overlapping interests of health communication and podcasting. He graciously agreed to be a guest on this podcast talking about his work as a standardized patient.

Kip describes himself as being passionate about better and more meaningful communication. This belief guides his work as a standardized patient with medical students and his work as a podcast host and producer.

Kip came to working as a standardized patient from a background in improv comedy. He’s a graduate of Kenyon College with a degree in English Literature.

Welcome, Kip, to Health Literacy Out Loud.

Kip Clark: Hi, Helen. Thank you very much for having me.

Helen Osborne: I have long heard about standardized patients. I thought it was a neat idea. But until I met you, I never knew anybody who actually is one. I was thrilled when you told me that you are. Please share with me, share with all Health Literacy Out Loud listeners, what a standardized patient is.

Kip Clark: Sure thing, Helen. A standardized patient is someone, usually an actor, working with medical students or soon-to-be clinical practitioners for the purpose of getting repetitions in, if you will, developing a muscle memory for how medical providers communicate with their patients.

Helen Osborne: Does this include the physical assessment, or is this the spoken word and the interaction part, the everything-but-the-physical part?

Kip Clark: Yes, at times it does include physical examinations and checkups. For the medical school that I have worked with here in the New England area, I have at times done that work with med students. But predominantly, at least in my role as a standardized patient, though it varies, I think, across the medical field, it’s primarily conversational.

Actually, during the pandemic, a lot of it has been done over video conferencing.

Helen Osborne: Oh, really? There’s no touching? I know that the medical profession is actually not physically touching as much as they used to, too.

When you are a standardized patient, are you Kip with all your own demographics, your age and your health status, or because you’re an actor, could you personify anybody?

Kip Clark: As much faith as I have in my acting ability, my demographic information is relevant. Often, a call will go out for, “Adults who could play between 25 and 40, we have these cases for you.”

Sometimes it will be, “Hey, these cases are about the menstrual cycle or women’s experiences,” so in that case, I, Kip, would not submit myself to play those roles.

Regarding me being Kip, that’s usually not an aspect of the acting portion, though I do think in how I give feedback afterwards about my emotional experience of the case, that is relevant.

But usually, I’ll take on a moniker, like Taylor or Casey, with a particular set of medical and, in some cases, emotional circumstances that that character is going through.

Helen Osborne: That’s scripted, I assume. Let’s take it from the beginning. How did you start doing this work?

Kip Clark: As you had mentioned at the top, I’ve been doing improv since high school. If any of your audience isn’t familiar with improv or improv comedy, in essence, you get on stage and you are acting, but you don’t have a script. You might get a single prompt from an audience member that sparks off all kinds of creative processes and dialog and you build from there. That started in high school.

Acting classes, I was on an improv troupe in college, and then after college, I was contacted by an old high school friend who had just graduated with a theater degree. She said, “Hey, Kip. I’ve started doing this work for this med school,” which I’m leaving anonymous in this podcast only for sake of respect in some things that I might talk about.

She said, “I would love, Kip, to talk to you about integrating improv and medicine. There’s this program that we’re starting and I wanted to know if you’d be interested,” and so she and I got coffee.

Initially, the work that I was doing was more geared toward improv. We were leading improv exercises to help get the med students to think more creatively and openly. But gradually, as I think is true of many people who try improv, it can be a bit too abstract and, I think, daunting.

Helen Osborne: Let me just do an aside. I took an improv course at my little local arts center. The first week I did it, I thought, “This is cool. I’ve got this.” By the second week, I’m saying, “Are we kidding? This is so hard.” Then the teacher was saying to me, “Don’t beat yourself up on it.”

I find improv hard, but maybe I’m a medical person. Maybe I represent the part that we just want to know what we’re supposed to be doing. Just tell me what to do and I’ll do it. But that’s me.

Kip Clark: I appreciate your self-awareness. I’m glad to be on this podcast as an improv or creative voice for that reason.

One of the things I love, frankly, about standardized patient work is I think there’s a lot of great work to be done between people who are more scientific and folks who are more creative. I don’t think they have to be separate. I think they absolutely can collaborate.

Eventually, the med students requested that we do less improv, and we shifted more to standardized patient work.

Helen Osborne: Tell us a story. I want to go through that experience of what it’s like, and if you can talk about your experience perhaps as a standardized patient, a little bit of that. But I’d like to hear more for those of us who are on the medical or public health side what we get out of this experience.

Also, a starter question. You talked about how improv is acting without a script. When you are a standardized patient, are you also acting without a script? Do you have to figure out how to have Disease X or Y, or are you given that scenario from whoever brings you in?

Kip Clark: That’s a great question. We are given what I would call, and this is isn’t intended to be medical wordplay, a skeleton of sorts.

Helen Osborne: Good word.

Kip Clark: I think we as actors flesh it out. We’re given the age range we’re playing, if we have this particular illness, or even we have a particular symptom that we as the patient can’t identify or place, but it’s a chest pain that’s been going on for three weeks and, “That’s why we came in to see you, Dr. X or Y.”

The medical student will often be given a bit of information entering the case. They don’t always enter it blind. Sometimes they do. That’s really up to the doctor or practitioner who’s administering this training.

Yes, we do have a decent amount of information going in as patients. I think where acting comes in is filling out some of the details therein.

We’re often told, “You work in an office setting doing this.” Some med students will ask, “Hey, Carl. Tell me a little bit about your day-to-day,” and that’s where we might fill in what we do in the office, how we feel about that work, etc.

Helen Osborne: What I’m gathering for that initial encounter that you have with this soon-to-be professional is that you know a little bit about who you are representing, and they know a little bit about you.

Indeed, that is what happens in clinical encounters. It’s usually not the physician or the highest-level medical person who firsts meets up with that patient. They’ve been through filling out history or charts, or been triaged or something, so they do know a little bit about each other.

Now you know who you are representing. They know a little bit about you. What happens in that time you have together as you’re playing the role of a standardized patient?

Kip Clark: Usually, the med students, as least those I’ve worked with, have in essence a script that they are encouraged to follow.

One of the most interesting parts of standardized patient work, at least as I have done it, is that we’ve been instructed, the actors doing this, not to elaborate on certain elements unless the med student asks a follow-up question.

Helen Osborne: Like what?

Kip Clark: Let’s say I mention that my chest pain is really sharp. If the med student says, “Oh, I’m really sorry to hear that,” and they move on to the next question, then I won’t elaborate.

But if they say, “Does the pain radiate at all? Could you tell me a little bit more? You said sharp. Could you tell me, Carl, what that pain is like?” in that case I’m comfortable opening up.

It’s really often something I’m looking for explicitly. Is this person making me feel comfortable enough, and this is a subjective call, to get into some of the more nuanced or complicated aspects of this case? It can be thorny. It can feel really sensitive or maybe embarrassing.

Some of the most challenging encounters are those where med students adhere so rigidly to the script that they actually don’t pick up on hints that I’m dropping, or if we’re in person, body language cues that I’m trying to send them that I don’t feel great or the topic they asked about is actually a really sore subject.

Afterwards, I will gently give them that feedback. A big part of the training is are they keeping their eyes open, and it’s tough because they’re juggling a lot, to what I’m giving off, all sorts of verbal and non-verbal information.

Helen Osborne: I’m getting a sense of this. I thought you’re just coming in as patient somebody or another who has this certain set of maladies and characteristics, and they’re just doing their part to find out who you are as a person, not just as a set of syndromes.

They’re evaluating you medically. At the same time, you as a standardized patient are really assessing that medical professional. Is that going on simultaneously? You’re both doing your own work?

Kip Clark: Yes, I think that’s a good framing. The clarification I would offer, and maybe this is splitting hairs on my end, is I would say I’m assessing their behavior or practice as opposed to the whole person. But yes, I am certainly examining what they’re doing.

The reason I make that distinction is that, to me, the most rich soil in all of this work is often the most vulnerable. It’s “What are our natural tendencies? What things do we miss in communication or overlook?” Not through any faults, but just because of who we are and how we navigate the world.

Feedback in those areas, I think, also requires a very gentle touch. I don’t want anyone to feel ashamed if they naturally don’t ask follow-up questions, because maybe that’s how they communicate.

Helen Osborne: Make it real for us. Give us an example of something that you might be thinking. You don’t want to give them feedback right then, right? You don’t say, “Hey, wait. Time out. You should have done this or that.” You wait until the end?

Kip Clark: In most cases, yes. There have been a few cases where my gut tells me, “This student is walking down the wrong garden path,” so to speak.

If it’s not an assessment which is being graded in some capacity, I’ll say, “Hey, I actually want to pause the assessment. I’m talking to you as Kip now, the actor. I’m not going to tell you why, but I would stick on this detail that I just gave you.” Then we can resume from there.

Sometimes I’ll do that. That’s a very small percentage of cases. But yes, for the most part, I give feedback at the end.

Helen Osborne: You talked about the behavioral process, or something that they’re doing that you’re going to tell them about later. It’s not the example you just gave about physically what they should be doing. I’m guessing it’s more like, “Listen more to the patient,” or, “Ask some more questions,” or, “Be a little more caring.” Is that the kind of feedback that you give later?

Kip Clark: Yes, absolutely. One of the top examples that comes to my mind is that there will be cases where a student will do a decent job asking initial opening questions or they’ll show empathy, and so I will open up and say, “The reason why I’m nervous about taking this statin or that other drug is my father actually, who recently passed away, had the condition I now have. They put him on all these medications and unfortunately he passed away. I’m terrified of going down a similar route.”

I act it out. I’m emotional in my portrayal of this character’s suffering and what that character is going through. I’ve been really surprised that some of the students listening to a 60-second monologue will say, “I see. How long have you been having these symptoms?” They completely breeze past what, to me, was sensitive.

There will be cases where, if I can, I try to bring myself to tears if it feels appropriate, and other cases where I very clearly try to convey a sense of distress. To be met with, I’d say, a more rigid reply . . .

I understand why the medical students might do that. They have a lot of questions they have to ask.

Helen Osborne: Right. There’s a lot to do.

Kip Clark: Yes. They might be first-year students very much still learning. But that’s the kind of stuff that I will give feedback on at the end, careful not to point it out as a character flaw of theirs but as something that would have helped invite me to be more open or trusting with them, that it is a partnership.

Helen Osborne: You have training in how to give that feedback, I assume. Is that correct?

Kip Clark: To a degree, yes.

Helen Osborne: But then you also talked about they might be graded on this. Is someone watching this?

Kip Clark: Yes, in certain cases. At the end of each year, I believe the first- and second-year students in the university I have worked at are recorded in some of these video training sessions.

They will watch those videos back to examine their own behavior, and a doctor who is a part of their team or department will also evaluate those videos, sometimes in real-time.

Helen Osborne: Wow. It sounds like a really tense situation actually when you’re both trying to appear comfortable.

You give them feedback. Then you two chat for a little bit after this is over?

Kip Clark: Yes.

Helen Osborne: That’s part of the process?

Kip Clark: Yes, they will come back into the room and I’m no longer Carl. I’m always Kip in those scenarios.

I find that to be the most rewarding part because I think if I give helpful and clear feedback, I give them some ideas they can play around with or potentially something that they hadn’t noticed.

Certainly, that’s built upon the standardized patient acting work, but the feedback is what really makes me passionate about it. I love that part of the work.

Helen Osborne: That’s neat, because patients don’t usually give their doctors feedback, except mine often asks me, “How did I do in health literacy?” and I give them a grade and we talk about it. But that’s only after I have a relationship.

It sounds like because you do this over and over, you have a good background to draw on in really comparing people and what works and what doesn’t.

I’ve got my big question for you, and that’s really speaking on behalf of listeners. Based on your experience doing this, what do you want listeners of Health Literacy Out Loud to know a little bit more about health communication?

Let me just describe our listeners. They might be clinicians, physicians or any other type of clinician. They might be in public health, they might be working in community organizations or we just want to know how to communicate a little bit better today. What takeaways would you like us to know?

Kip Clark: That’s a great question and something I think about a lot.

I think one aspect as an outsider to the medical community, as I am not a scientist, that I perceive is a philosophy that science and medicine espouse, and one that I think works in many situations, which is that with hypothesis and testing, we can get to answers. We can figure things out. There are solutions and things that work.

To me, what is tricky or even dangerous about that in a communication environment is that I think it removes the human element.

There aren’t one-size-fits-all rules to dialog and communication. I think there are best practices, like gentleness, compassion, etc. But where I’ve often struggled as a standardized patient or where I’ve felt maybe emotionally distanced from the med students is when they use phrases that they’ve clearly been taught and they don’t quite make it their own.

Again, I understand why they’re doing it. I’m not upset with them. But I often notice, “I don’t really feel emotionally connected right now because I’ve heard this exact set of words used before, and in fact 30 minutes earlier with another med student.”

I think the following is maybe a difficult piece of homework or a challenge I could pose, but I think the best interactions I’ve had with med students or any other medical providers in this capacity is when I get the sense that they are bringing their authentic selves to the interaction.

It’s certainly still a professional environment, and they certainly still know a great deal, but I don’t feel as though I am being treated as a case. When I see that they are human, I feel a little bit more comfortable opening up and being human.

One way I think I could condense this perception I have is that many of us listen in and out of the medical community with more of a hunting attitude. We’re seeking a very specific answer, idea or thought, and while that gets us to some results, I think dialog needs to be a little bit more flexible to where someone might go.

I would offer that if a patient feels comfortable enough telling you about some trivial detail about their lunch today, and you respond positively, they might actually now feel comfortable telling you about a more vulnerable or intimate aspect of their medical difficulties.

Contrary to maybe a hunting piece of imagery, I would think about fishing. Sometimes you put a line in and nothing bites, but you are very much waiting and open to, in that case, whatever fish might come along. I think that approach to listening and being patient is, to me, the most effective.

I know medical providers don’t always have the time, but that has been, to me, profoundly important.

Helen Osborne: What I’m hearing from you, Kip, if I could just put a close to this now, is that you as a standardized patient would like health communication to be less standardized.

Kip Clark: That’s very well said. I completely agree.

Helen Osborne: So that the humanity of the receiver of the care and the giver of the care both are authentic. The way you do that is through acting, and the way they learn that is through practice and feedback.

Kip Clark: Absolutely.

Helen Osborne: Kip, thank you for sharing your experiences, perspectives giving feedback to students and for helping us all be better at health communication. Most of all, thank you for sharing it with us on Health Literacy Out Loud.

Kip Clark: I am very glad that I could. Thank you for the invitation.

Helen Osborne: As we just heard from Kip Clark, it’s important to consider both sides of health communication and bring not only our knowledge and our skills, but also our authenticity and humanity to every patient encounter. But doing so is not always easy.

For help clearly communicating your health message, please take a look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out the first of every month. Get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

Please help spread the word about Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters. Until next time, I’m Helen Osborne.

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