Fictional patients as literature search examples

Not simulated patients used in exams, but fictional patients as literature search topics.

I have used fictional patients for some years.   I looked back to see if I have ever given them names, and can't find any evidence of that.   That is good, as perhaps there is a danger the names would not be diverse.  

For the medical students who started in 2017, I had this:

"Your patient is a five year old with head lice.    Their parent asks if they should use an insecticide lotion to eradicate the lice.    Will this work, and better than the alternatives?   Are there any adverse effects?"  

and this

"Your patient is aged 70, and has arthritis.   They want to know which painkiller they should take.    What evidence can you find about painkillers in arthritis, their effectiveness and their side effects?"

I was pleased to see I had said "they" and "their".

For a reason I can't recall, I changed approach, so the first years who started in 2019 had this:

"Clinical trial of iron chelating agents in haemochromatosis in adults"

I think I prefer the original approach, so fictional patients might return for 2020's cohort, who I meet in February next year.  

My library (re)induction for fifth year medical students had a "scenario":

"You meet N, who has acute lung injury

While taking a history they mention they engage regularly in vaping

You’ve read about EVALI…

…and wonder if vaping is linked to acute lung injury?

Could N have EVALI?"

Also a they, and with a name that makes no assumptions about their gender, age, ethnicity.

For my session with the physiotherapists and nurses in 2018, I had a fictional patient (client) in mind when I looked at finding resources about exercises for people with vertigo.   Except they were not fictional, they were my Dad.    I did not tell the students, but I did tell one of the teachers (because I wanted some advice on what help Dad could get access to and how).  The teacher remembered when I used the same "fictional" patient (client) in 2019, and asked me how he was.

I don't know if I would have used him if he had had another health condition, like cancer, although I have definitely used examples in the past brought to mind by someone I knew, without ever telling anyone and certainly without telling that person.   Perhaps that raises more ethical questions.     Perhaps the cases in books of medical cases are similarly based on people known to the authors.

I think I told Dad I had used him as an example.   Certainly I passed on some information I found when testing my scenario, and I passed on my teaching colleague's advice on how to access the help that there might be.  

Dad sadly passed away in March this year.   I decided to keep the same example for this year's session, and I added a lovely photo of Dad on holiday in Shetland, a place he loved and visited many times with Mum.  I told the students that my fictional patient was not fictional, and was actually Dad.  I did take the photo out before sharing the slides in the VLE, though!

I like to think that Dad was happy to be an example used in teaching trainee health professionals.   He worked in education for years and years, and certainly had a positive impact on many students.   I remember many times as a boy walking into town with him, meeting someone who came over to say hello to Dad, and me asking who that was, to find out it was a student or former student.   And he was certainly happy to be involved in a research project as a patient.   So I hope he would be ok about appearing in undergraduate health education.