Communication skills OSCE

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  1. General important points in communication
    • Get a brief history and ascertain the patient's reasons for coming to clinic
    • Get an idea of the patient's undertanding of a disease/procedure
    • DON'T assume a patient knows the risks of their disease, e.g. diabetics and eyesight/kidney/vascular damage
  2. Important points in smoking advice
    • Find patient's reason for coming in, brief history and diagnosis (e.g. leg pain)
    • Talk about risks of smoking to the patient (lungs/heart)
    • Find out more about smoking: triggers, barriers to stopping, past attempts
    • Benefits of stopping, available support therapy, self help
  3. Information on gastroscopy
    • Fast 8-12 hours beforehand with antibiotics and some drugs stopped
    • Lasts 10 minutes, but allow 2 hours for appointment
    • Anaesthetic spray +/- IV (memory loss). Mouth guard. Pain free normally
    • Endoscope thin, flexible tube via mouth. Swallowed.
    • Air (image improved) or biopsy may be taken
    • No operating machinery <24hrs. Avoid eating/drinking until anaes. wears off
    • Results given immediately, unless biopsy or sedated
    • Risks = sedative adv. rea. sore throat, teeth damage. Perforation/aspiration pneumonia/IV infection.
    • Contact hospital if fever/dyspnoea/haematemesis/pain <2 days after
  4. Information on colonoscopy
    • Lasts 30 mins, no driving/machinery <24 hours
    • IV sedative to relax, not general anaesthetic
    • Air passed into colon. May cause flatus; expected.
    • Imaging results given at end unless biopsy. Can bring companion to hear them.
    • Pain free, but wind/cramps for hours after. Mild rectal bleeding.
    • Risks = significant colonic bleed/perforation
  5. Information on HIV test
    • Two blood samples taken: one immediately and another 3 monthsa fter
    • If positive, means HIB present and infection risk but NOT defo aids
    • If negative, means no Ig found but NOT in the clear due to window period. Patient NOT immune
  6. Taking a sexual history
    • Assure confidentiality, including contract tracing and partner notification
    • Partners: Sex with men/women/both within 12 months
    • Pregnancy: Include desire for or measures to avoid
    • Protection: Any protective measures against STDs
    • Practices: Oral/anal/"anything else". Performing/receiving
    • Past: Sexual history of both patient and partner(s)

    Never ever ever say 'loyal' at any point during this consultation
  7. Information on bronchoscopy
    • Requires travel to/from hospital
    • Lasts 20-30 mins, but 2 hours for appointment
    • Thin tube passed down pharynx via nose, biopsy/remove fb
    • Requires mild sedation while sitting/lying. No talking
    • Mouth+nasal anaesthetic spray or IV (relax). No pain
    • Heart rhythm, O2 measured (ECG and oximeter)
    • Results given immediately unless biopsy/sedation
    • No swallowing after. Always a little blood.
    • Risk = sore throat, hoarseness, cough, fever. Pneumothorax/pneumonia
  8. Information on mammogram
    • Screening or diagnostic (50-70yrs or Br-Ca/Br-Sur Hx)
    • No deodorant/powders/lotion/jewellery worn
    • Takes around 30 minutes
    • Not given in possible pregnancy or breast feeding
    • One breast rested on flat surface and compressed from above - improves image and reducing dosage.
    • Uncomfortable. Several angles/postures may be required
    • Results sent to patient + GP. If nothing heard DON'T assume its clear.
    • Further invest = repeat, US, aspirate or guided biopsy
    • 5-15% require further investigation. 30% false +ve
  9. Taking an alcohol/drug history
    • Where is the patient in managing problem? Considering stopping/want to but can't start?
    • Establish how the problem affects life
    • Ever felt the need to cut down?
    • Have people suggested cutting down? How did they feel?
    • Have they ever felt guilty?
    • Have they ever taken the substance to wake up
    • Identify something the patient wants but can't have because of problem, e.g. can't visit child
  10. Important points in accessing records
    • Data protection act 1998: Right to apply for access to health records/obtain copies
    • Freedom of information 2000: Access to all types of records
    • Access to Medical Reports Act 1988: Employer has to let patient know if they want records. Patient can refuse but may not be employed. Doctor can amend records if not related to job prospects/incorrect info.
    • GP has 21 days to comply to request
    • Fee may be required9
  11. What are the Fraser guidelines
    • Contraceptive advice and prescription can be given to a minor
    • Child must have capacity
    • Child cannot be persuaded to tell parents
    • Child would continue sex with/without treatment
    • Mental/physical health of child at risk without treatment
  12. Describe the right to refuse treatment
    • An adult may refuse treatment even if life threatening (if has capacity)
    • A minor can consent to treatment if they have capacity, but cannot refuse if refusal would result in death/permanent disability (doctor and court discretion)
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Communication skills OSCE
2012-06-23 16:20:18
Procedures lifestyle advice

Procedures and lifestyle advice
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