Ashley L. Voss looks at Corinne May Botz’s exploration of the strange world of standardized patient interactions.
Originally published on Pelican Bomb.
Within a sterile environment, a patient awaits with empty eyes. Maintaining correct distance from the subject, a doctor nervously recites a series of questions. The patient, knowingly guiding the discussion, provides answers to fill the gaps within the narrative. Welcome to the hauntingly familiar world of standardized-patient (SP) simulations. SPs are professional medical actors trained to present particular sets of symptoms in order to help medical students improve their diagnostic skills and bedside manner.
Engaging this strange training ground, artist Corinne May Botz’s Bedside Manner is an 18-minute video and a series of photographs that examines the performative aspects of doctor-patient interactions to parse issues relating to empathy and authenticity. Intrigued by the dynamics of SP simulations and inspired by neurologist and writer Alice W. Flaherty’s work, Botz began a year-long process in 2012 to secure permission to access clinical skills centers throughout New York City. Botz contacted Flaherty and asked her to participate in the documentary project with the intention of exploring the performative aspects of medicine—Flaherty appears as herself and in the role of multiple standardized patients.
It wasn’t until the editing process that Botz became aware of the film’s focus naturally shifting to incorporate more of Flaherty’s personal history. In the film we learn Flaherty’s interest in understanding the roles within the medical field stems from the lack of empathy displayed by her obstetrician upon the death of her premature twins. Playing multiple roles within the film, Flaherty learns how to be a patient in order to help other doctors incorporate compassion into their practice.
The video begins with the drawing of a curtain to reveal a behind-the-scenes view of a medical center. With this simple action, Botz directs attention to the viewer’s own presence, which is similar to that of a medical professor observing SP interactions through a one-way mirror. In these simulations, both doctor (medical student) and patient (SP) are aware they are being observed while playing specific roles, however, they are instructed to “suspend disbelief and rehearse for trauma.”
Flaherty first plays the role of a patient with delirium while a montaged series of medical students attempt to properly diagnose her. The ritual gestures and phrases of these interactions are seemingly robotic: a sanitized handshake to develop rapport, a depersonalizing white lab coat to establish authority, and rehearsed hand motions to correspond with inquiries. Common clinical questions are recited—a doctor asks, “Do you use any illicit drugs?” to which Flaherty replies, “I don’t think I would tell you if I did.” Insecurities ensue as the doctors’ patience and qualifications are tested.
These tense scripted interactions transition into improvisation, making the encounters feel relatable. Nervous mannerisms displayed during the doctors’ performances underscore the process of becoming a professional in the medical field. Doctors need to convince patients they are more competent than they may sometimes feel, since they have the authority to decide what is relevant for proper treatment. The vivid reversal of the traditional medical gaze in the SP interactions—patient examining doctor—emphasizes the isolation and anxiety a patient could feel when relying on someone else to interpret their body for them.
The video regularly reminds viewers of their presence by emphasizing the sterile architecture of medical complexes and the intense physical and psychological realities of these structures. Moments are monitored to the beat of a blinking red light emitting from a surveillance camera. Curtains shift in subtle acknowledgment. A mysterious tunnel between the one-way mirror is used to pass written messages, eliminating the communicative distance between the observer and the doctor-patient performance.
In contrast to the video, the photographic works in Bedside Manner often focus on the standardized patients. Without the explicit context provided by the video, many of the photographs appear at first to be journalistic portraits of patients and not of actors in an SP setting. The burden of the clinical gaze prevails as patients are on display. A woman wearing a navy medical gown grasps her legs in Lori, 2014. A painting of a doctor with clasped hands hangs on the wall behind her, bitterly emphasizing the patient’s longing to be helped. Here, she seems to be just another medical subject, brightly lit on her side of the one-way mirror. Unable to discern patient from SP, viewers are prompted to question how acting affects their everyday lives. Assuming various roles is a method people use to communicate and empathize—and ultimately a path toward understanding each other.