Subject: Friend, OSCE Made Easy: Breaking Bad News, HIV positive using OSCEhome question boxes

Hello Friend,


I wanted to share this with you..

I received an email asking about how to use OSCEhome questions boxes to perform in an OSCE station for a patient coming to your office for his HIV test results.

Here is exactly what you have to do in this OSCE station and in your real life clinical patient interview..

OSCE Station stem question:

 

Mr John Brown came today to your office for the result of his HIV test. Please talk to him for the next 10 minutes.

……………

 

How to perform during this OSCE station?

 

Merging questions boxes from Chapter 14 of the ebook (A Step By Step Guide To Mastering The OSCE And Clinical Patient Encounter) with Chapter 4 of the ebook “How To Unlock Difficult Medical Encounters).

 

1-     The minute before box:

Similar to the History taking model.

 

 

Breaking bad news box:  SPIKES

 

Setting:

 

 Choose a calm place with privacy. Have tissues nearby. Never by phone.

 

2- The Introduction box:

      Similar to the History taking model.

Ten steps to be performed in this stage of the medical encounter in 15 seconds:

 

1-            Give the examiner your sticker, smile and move on (if applicable).

 

2-            Approach the patient while smiling and relaxed.

 

3-            Identify the patient: “Mr/Ms…..?” in a questionable tone.

 

4-            Establish a sense of privacy: Draw a curtain / close the door / suggest that a visitor wait outside (Accept the patient decision).

 

5-            Introduce yourself confidently, softly, friendly, comfortably:

         “Hi, I am Dr …….… (last name)”. Shake hands, if you want (Preferred).

 

6-            Mention your position: one of:

- in your office: nothing more.

- in a colleague clinic: “I am covering for Dr….today”.

- in a walk in clinic / ER: “I am the physician on duty here today”.

 

7-            Ask the patient about how he/she would like to be addressed:

Mr/Ms….., how would you like me to address you?

 

8-            Quickly screen the room: Where is the patient, your chair, stretcher, and TOOLS. Tools in the room are more likely meant to be used.

 

9-            Ask the patient to sit down (pointing where) if he/she is not already sitting or lying on a stretcher. “Be seated/ lie down (if needed) here please.

 

10-        Then sit down. Don’t move the chair closer to or away from the patient. Ideally about a meter far and in a narrow angle.

 

Perception:

 

3- The Initial Counselling questions box:  KNOWS Why

 

Mr/Ms …, what brings you here today? / I understand you are here today for your HIV test results”.

 

1-      Current Knowledge:What do you know about HIV? Or What is your understanding about what is happening HIV?

2-      Need:What would you like to know about HIV?,  What questions did you hope get it answered today?”…. “So, you want to know….

3-      Observed:Have you had any experience with HIV in the past?

4-      Worry:Is there something you’re worried about concerning the HIV?

5-      Searched:Have you talked to someone about HIV or read some information or searched the net?

6-      Why:Why now?,.. What triggered this issue? Why did you want to be tested?”.

 

4- Invitation:

 

How would you like me to handle the information about what is going on?.. Are you the person who wants to know everything in detail?

 

 “Is there a family member or a friend that you want me to tell?.. …..

If he replied: ‘Don’t tell me’:

That’s okay.  … Whenever you have a question, call me, okay.

 

5- Knowledge:

 

If he/she wants to know, inform him/her clearly and honestly the facts.

The investigations/ biopsy came back positive for HIV

“Your partner/ husband/ father/ son…., has passed away.”

SILENCE. Watch your non-verbal gestures.

Educate about the disease or about what happened in small chunks asking him in between: “Am I making sense?” or “Is that clear?

 

“Positive HIV test does not mean that you are having AIDS.”

“ HIV and AIDS are a chronic slow progressing illness that will stay with you and takes years to cause serious issues.”

“We need to repeat the test for confirmation.”

“Do you have any cough?…, fever? …, weight loss?..., night sweating? …, anorxia?...” Symptoms of AIDS.

 

6- Explore his emotions:

 

This is very distressing knowing that for the first time?.. That must be a terrible feeling…  I am sorry.

GIVE TISSUE, AND SILENCE FOR FEW SECONDS.

 

“Do you have any suicidal thoughts?”

 

If he/she asks: “Why me?”: See Caring of the terminally ill patient.

 

7- Strategy (Wrap up):

 

Wrapping up counselling box:

1-      “Okay Mr/Ms…is there anything else you’d like to tell me or ask me?

2-   Negotiate with him/her an agreed upon PLAN OF ACTION. A CONTRACT. Clarify his/her and your responsibilities:

Okay, so I’ll send you for the investigations, you will take the medication/ change your life style and report progress”.

Doctor obligations:

  1. 1.      “I will send you to repeat the test.”
  2. 2.      “I have the obligation to report this result to Public Health Office. They will contact you for further information and mandatory issues to be done.”
  3. 3.      “I’ll give you a hotline number to contact if you feel you need to talk about your condition.”
  4. 4.      “I’ll arrange for a follow up appointment to see.”

 

Patient obligations:

  1. 1.      “You have to tell your partner or partners about this result yourself as the Public Health Office will inform them anyway.”
  2. 2.      “You have to practice safe sex, that is to use condoms every time and no oral sex. Avoid sharing utensils, toilets and anything that comes in contact with your body fluids.”

 

3-      Follow up: “I want to see you next week / in a month.”.

4-      Last word in the interview is for the patient: “Is there anything else you’d like to tell me or ask me?”.

5-      “It was nice to meet you, have a nice day.

 Done....

 

Get it the complete OSCEhome ebook package at www.oscehome.com  and try it without any risks.

Have a nice day.

OSCEhome team.
www.oscehome.com