Currents in Electronic Literacy

Playing Doctors, Playing Patients:
Multi-user Domains and the "Teaching" of Illness

by Lee Rumbarger

  1. I teach a rhetoric class on illness narratives to University of Texas undergraduates. The course, "Illness and Testimony," looks at a battle of stories: a battle between the myths and images attached to certain illnesses and the people who resist these stories by telling their own. We analyze social and medical narratives about people who are ill and then read patients' own writings to see how they reclaim narrative control of their identities.

  2. This topic is a challenging one: Students must become sharp readers of real-life experience and thoughtful listeners to others' stories. UT's Silver Sea MOO offers a "place" to practice both. Here, students use the Internet to take an imaginative leap into the skins and psyches of doctors and patients. Such role-playing in a virtual environment invites students to invest their imaginations, as well as their growing rhetorical skills, in the cares and care of others.

  3. This paper details a role-playing project undertaken by my students and offers some of their responses to it. It also, I hope, suggests the value of Multi-user domains for students and instructors whose course material--like mine--grapples with "embodiment." By asking students to interact "outside" their real bodies, MUD role-playing allows a glimmer of experiential understanding of what it's like to inhabit the body of another. This MUD technology is a sophisticated, exciting teaching tool for three of my major course lessons: that our bodies shape how we view the world and are viewed in it; that bodies can never define us entirely; and that narrative facilities help us define ourselves as we choose.

    How it Works

  4. Each of my students receives an envelope--their identity pack--with a roughly sketched character profile. Half are doctors, the other half, patients. They know what ails them, or what ailments they'll consult about (all ailments are fraught with stereotypes they've just spent several weeks identifying and dismantling). They know if they will lead the discussion, or follow their partner's lead. And they know the number of their "examining room." The rest is up to them. Here's a sample identity profile:

    Welcome to Playing Doctors, Playing Patients: A Virtual Exchange! In this game identities are fluid. You will play a patient who has had a cancerous growth removed. On March 20th, you'll talk to a new-to-you doctor about psychological issues you've had since your surgery. You are the lead. You'll be in Room 5 of the Wellness Center.

    Students flesh out their identity pack profiles. They create a character, find an image to represent that character, research their ailment, and write a 2-3-page character bio and (most importantly) analysis of their choices in creating the character. All are invited to embody or challenge stereotypical representations as they choose. And, indeed, their characters range from Norman-Rockwell-esque paternal physicians and "angelic" young women with leukemia to HIV+ soccer moms and women-of-color oncologists. Students also devise a 1-page strategy sheet of things they plan to say to their doctors/patients; persona-true "guidelines" for their emotional responses; and ways to complicate, cool down, or heat up their interaction.

  5. I've created a "Wellness Center" in the MOO to host this project. The images I used for the Center's rooms are of a "dreamy," imagination-inflected clinic. In keeping with the MOO's Silver Sea theme, identities are fluid here: Students pass through a pane of water to enter a blue reception area and walk down a "liquid hallway" and into their appointed examination rooms. The images, of course, only matter inasmuch as they create an appealing game space for the students. I've loaded all their character images and descriptions into the MOO so that when doctor and patient "meet" they are able to see with whom they're interacting.

  6. This game is a demanding one, requiring students to keep up a 30-minute, in-character, typed dialogue. It requires agility with the course material, an imaginative taking-on of another's subjectivity, a powerful encounter with assumptions surrounding how "sick" and "healthy" and "broken" and "whole" people look and act.

  7. Students ultimately write an evaluative argument about their role-playing, deciding if their doctor-patient interaction was a positive or negative one based on criteria they establish. Virtual tape recorders in each room provide full transcripts of all that's spoken and gestured to help students offer very specific evidence in their papers.

    A Serious Game

  8. When student doctors and patients meet, they find that the images they've selected to represent themselves (their "bodies") often over-determine their partners' responses to them. They must find the words to assert--even defend--the characters they've labored to create in the face of another's perceptions. Their role-playing interactions are fraught with all the conflict, disorientation, and disconnected communication of real-life doctor's office dynamics. "It is always strange to meet someone new and open up to them," writes one freshman in a post-game discussion forum. It is strange in life, and strange with her anonymous "doctor" classmate, she explains. A student "doctor" writes, "The 'patient' I interacted with really threw me some curve balls. Some of the questions she had I didn't really know how to answer, and [I didn't know how to respond to] some of her 'outbursts' or breakdowns. . . . As diverse as the English language may be, sometimes words are lacking."

  9. The role-playing illustrates the strain of disappointed expectations. The game "was very frustrating because I (as a patient) wasn't hearing what I wanted from my doctor," writes one student, whose character was a man with an eating disorder. Her doctor writes, "My patient was very stubborn, and somewhat rude." In response to this patient, she said, her character appeared increasingly unskilled and relied too heavily on small jokes to maintain the conversation. The transcript from their interaction shows how these two characters, despite a seemingly smooth start, struggle to define themselves in the face of what each views as the other's misconceptions about him/her. The doctor repeatedly asserts his authority: "You can call me Doctor"; "I've won tons of awards"; "I'm the highest paid doctor in this state"; "I know what's best"; "I want to be recognized"; "I'm the doctor." The patient, angered by his doctor's confidence and quick assumptions, asserts the complexity of his situation and the depth of his despair: He cries, "huddles into himself," and claims no one understands him.

  10. Another twosome, Dr. Knox, a surgeon, and Rebekah, a breast-cancer survivor, find that what one needs, and what the other feels comfortable giving, are very much at odds. Rebekah seeks reassurance that she'll be able to feel comfortable in her marriage and in her role as mother despite her mastectomy. She is insistently personal, forcing her doctor out of "doctor-ly" clichés and into intimate revelation. Rebekah's intense, unstaunched emotion demands a person-to-person, rather than doctor-to-patient, communication:

    Knox: Yes, treatment is difficult mentally and physically, but if you keep your head together you'll be back to normal soon.

    Rebekah begins to cry. [. . .]

    Rebekah: Tell me, Doctor, if your wife lost both her breasts, would you find her repulsive too? [. . .] Tell me the truth. You would, wouldn't you? You married a woman, and that's what you want. But now, what am I?

    Knox: Half your battle with cancer will be psychological. You've got to focus on the long-term goal. [. . .]

    Rebekah: I'm not even the woman my husband married.

    Knox: No physical change could make me leave my wife.

  11. Student doctors and patients shake hands, hug, look each other in the eyes, stare into space, back-pat, and draw back. They seek to connect and be understood--and to remain true to the characters they've created and the things they initially thought would be important to say. "With this project, we not only got the chance to build the character, we got to BE the person," writes one student. "It really was interesting to try to figure out how to respond as a character to an outside force."

  12. My students' responses to this project were overwhelmingly positive, and several reported that they gained keener eyes for evaluating their own interactions with real-life doctors. And it is, of course, exciting to see students learning to respond eloquently and true-to-character in the face of any andall "outside force[s]." They see the high stakes of rhetorical power while--just as in working their way through this rhetoric and composition course--their own rhetorical powers are taking shape.
Please cite this article as Currents in Electronic Literacy Spring 2002 (6),