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Learning To Heal Virtually

A "virtual patient" named Louis Garcia is teaching medical school students how to handle complicated sample cases of illness they might not confront otherwise.

Based on a real patient treated by Dr. James McGee, a gastroenterologist at Beth Israel-Deaconess Hospital in Boston, Garcia is so sophisticated that diagnosing and treating him is pretty close to a face-to-face doctor visit.

Type in a question about Garcia's health and a videotape of him answering immediately pops up. An actor was taped answering every question Harvard Medical School's physicians and professors could think of.

Teaching medical students how to deal with a tricky case like Garcia's is getting more difficult in today's health-care environment: With more outpatient care and shorter hospitalizations, there's less time for hands-on learning about certain illnesses at the side of the experienced physician.
That's why Harvard is programming virtual patients with conditions ranging from HIV and chest pain to depression and pregnancy.

Student-doctors conducting a "physical exam" see close-up video of the patient's body. Even the faint curve in the spine of a different, female virtual patient clearly shows, a sign of her bone-destroying osteoporosis.

The simulators "won't replace real patients by any means," McGee stresses. But they give student-doctors more practice with conditions they may not see enough in medical school, so they're better equipped before treating your family.

They're like flight simulators that pilots use -- better to learn by hurting a virtual patient than a real one.

Indeed, the simulators pose numerous pitfalls for would-be doctors, whose every decision, and every mistake, is analyzed.

"You just ordered $740 of unnecessary medical tests," the simulator interrupts at one point.

Another lesson: Plan ahead. Take virtual patient Carolyn Smith, a 79-year-old who fractured a hip four years ago but complains that "I'm still wobbling" and seems to be getting shorter.

Classic osteoporosis signs, so you ask about calcium in her diet, osteoporosis in her family and whether she's ever taken estrogen, a hormone that protects women's bones. You examine her spine and run a few tests, including ruling out a bone-weakening thyroid problem.

"Whoa," the simulator says, "you forgot to order a mammogram." A breast X-ray for a bone complaint? Yes, because if you ultimately prescribe bone-protective estrogen, you first need to know she is free of breast cancer that that hormone can stimulate.

Virtual patients even teach the art of talking with and educating worried patients.

Smith's mammogram, for instance, finds a slight abnormality that a radiologist might merely want to re-examine in six months. A frightened Smith demands a biopsy. At some point, the med student realizes that salving a patient's feelings can be worth an unnecessary test.

And one day Smith's teen-aged granddaughter accompnies her to the "doctor." Knowing osteoporosis is in the family, a good student-doctor will wheedle out of the girl the admission that she chooses Coke over milk and shuns other calcium-rich food like broccoli.

"We want to teach how to work with people to prevent disease," McGee explains.

Some medical schools already use various types of simulators, but Harvard says its version is more lifelike, allowing multiple patient interactions over time and numerous outcomes.

They're expensive, costing over $200,000 each to create, funded mostly by the nonprofit Macy Foundation.

But Harvard says the virtual patients are important enough that it currently is negotiating to create a library of simulators available for every medical school.

Written By Lauran Neergaard