Place a cold metal stethoscope on his chest. He won’t flinch.
Have difficulty finding his pulse? He’ll never complain.
His blood pressure won’t even rise with nervousness if a whole class of medical students lines up, each student eager to examine him for a suspected heart disease.
That’s because this good-natured patient isn’t real. He’s a medical manikin developed at the University of Miami, and he simulates symptoms of dozens of cardiac ailments. Christened Harvey, he is used at medical schools, hospitals and other institutions in the U.S. and half a dozen other countries.
Thanks to electronic wizardry, Harvey’s chest rises and falls as he breathes. A heartbeat can be felt. Touch his neck and there’s a pulse.
Plug in the appropriate audio cassette and, with the flick of a switch, Harvey will mimic one of 26 heart problems, from murmurs to defective valves-or sound perfectly healthy.
Depending on which disease has been selected and how severe that disease is meant to be, Harvey’s breathing, pulse, blood pressure and heartbeat can all be altered, providing diagnostic clues.
Three Harveys reside at the university’s Medical Training and Simulation Laboratory for use by medical students, interns and residents, as well as by practicing nurses and doctors who want to sharpen their diagnostic skills.
Dr. Joan Mayer, director of cardiology teaching programs at the university, likens doctors in training using Harvey to pilots-to-be practicing on flight simulators.
“You can read all the books you want that describe a pulse or an impulse or a murmur,” Mayer said. “But you still haven’t experienced it, so when you go to the bedside, you don’t really know what you’re looking for.
“So this doesn’t take the place of examining patients, but supplements it,” she said. “It makes examining a patient a lot easier because you know what you’re looking for. So you can hear the heart and feel the impulses, and the patient never complains if you have to do it again and again.”
Dr. Michael Gordon, director of the simulation lab, is credited with spearheading Harvey’s development.
It was getting harder to find enough sick patients for medical students to examine, because hospitals do more surgery and testing on an outpatient basis.
Getting easy access to a range of patients exhibiting several dozen heart diseases is unlikely, and those that are found don’t want to be continually prodded. A computerized manikin with the ability to mimic a variety of illnesses seemed like a natural.
Gordon named the manikin after W. Proctor Harvey, one of his former teachers at Georgetown University who stressed the importance of physical exams and medical history-taking when diagnosing heart disease.
Forty-two life-size Harveys have been sold since the first one was delivered to Duke University in 1978. Seven have been sold abroad, to institutions in France, Germany, Israel, Italy, Japan and Thailand.
Lecture slides used in conjunction with Harvey have been translated into Spanish, Japanese, German and French.
A medical school in Bogota, Colombia, is also interested in the manikins, Mayer said.
The university doesn’t have a formal marketing program to sell the manikins, which cost about $110,000 each and were developed by Gordon and a team of cardiologists from several major medical centers, including Duke, Emory University and the Mayo Clinic, as well as the Universities of Arizona, Florida and Illinois.
The manikins are manufactured in the simulation lab by electronics experts; the plastic skin is supplied by an Atlanta company. Cardiologists from a U.S. medical school will soon look over the newest model. Harvey has been updated and can now exhibit more heart diseases.
In the past three years, just three manikins have been sold. Though the price is about $10,000 less than it was several years ago, some say Harvey’s cost could be keeping down sales. And many medical schools prefer teaching techniques that are effective without a manikin.
In recent years, as computers have gained importance as a teaching tool, the medical school has expanded its focus to include a computerized training system. Called UMedic, it uses graphics, sound and video, and it includes scenes of heart surgery and many diagnostic procedures.
Now used as part of a national study, UMedic will be ready for distribution later this year, said Diane Issenberg, director of administration and fiscal affairs for the simulation lab.
The medical school is also developing a computerized program for paramedics, expected by 1995.
In the early days, University of Miami medical school physicians carted Harvey across the country to cardiologists’ meetings to demonstrate their innovative teaching tool-quite an effort, as the average Harvey weighs 1,000 pounds and is about 7 feet long. But those meetings drew doctors from around the world, fueling purchases.
It was at one of those meetings that heart specialists from Hadassah Hebrew University Medical Center in Jerusalem first saw Harvey. That hospital became one of the first to buy the manikin.
Many of the 100 medical students at Hadassah use Harvey from two to six hours a week, said Dr. Morris Mosseri, the cardiologist in charge of Hadassah’s cardiology program.
“We’re very pleased with Harvey,” he said. “The students like it very much. The strategy is that they can examine the machine for as long as they want, something they could not do with a real patient.”
