RxPG - the perfect Rx for medical Post Graduate entrance blues!
Mobile Edition | Help/Newbie? | 24/7 Support
HOT | PrePG | MCQ | DNB | Careers | Books | Colleges | Dental | DocIndia | PLAB |  USMLE  | Australia | Canada | GLOBAL | OffBeat!
Articles | Forums | MCQ Crammer | Downloads | Mnemonics | Revision Tools | Recent Shouts | All Features


A six step protocol for breaking bad news!

Author: tegs, Posted on Saturday, June 28 @ 20:26:53 IST by RxPG  

 FRIEND Add to My Pages   PRINTER Printer Friendly   FRIEND Email Story  FRIEND Download Story  PLAB Part 2 alerts 

PLAB Part 2

This is a very frequent station in the OSCE. The steps are:

1. Getting started.
The physical setting ought to be private, with both physician and patient comfortably seated. You should ask the patient who else ought to be present, and let the patient decide--studies show that different patients have widely varying views on what they would want. It is helpful to start with a question like, "How are you feeling right now?" to indicate to the patient that this conversation will be a two-way affair.

2. Finding out how much the patient knows.
By asking a question such as, "What have you already been told about your illness?" you can begin to understand what the patient has already been told ("I have lung cancer, and I need surgery"), or how much the patient understood about what's been said ("the doctor said something about a spot on my chest x-ray"), the patients level of technical sophistication ("I've got a T2N0 adenocarcinoma"), and the patient's emotional state ("I've been so worried I might have cancer that I haven't slept for a week").

3. Finding out how much the patient wants to know.
It is useful to ask patients what level of detail you should cover. For instance, you can say, "Some patients want me to cover every medical detail, but other patients want only the big picture--what would you prefer now?" This establishes that there is no right answer, and that different patients have different styles. Also this question establishes that a patient may ask for something different during the next conversation.

4. Sharing the information.
Decide on the agenda before you sit down with the patient, so that you have the relevant information at hand. The topics to consider in planning an agenda are: diagnosis, treatment, prognosis, and support or coping. However, an appropriate agenda will usually focus on one or two topics. For a patient on a medicine service whose biopsy just showed lung cancer, the agenda might be: a) disclose diagnosis of lung cancer; b) discuss the process of workup and formulation of treatment options ("We will have the cancer doctors see you this afternoon to see whether other tests would be helpful to outline your treatment options"). Give the information in small chunks, and be sure to stop between each chunk to ask the patient if he or she understands ("I'm going to stop for a minute to see if you have questions"). Long lectures are overwhelming and confusing. Remember to translate medical terms into English, and don't try to teach pathophysiology.

5. Responding to the patients feelings.
If you don't understand the patient's reaction, you will leave a lot of unfinished business, and you will miss an opportunity to be a caring physician. Learning to identify and acknowledge a patient's reaction is something that definitely improves with experience, if you're attentive, but you can also simply ask ("Could you tell me a bit about what you are feeling?").

6. Planning and follow-through.
At this point you need to synthesize the patient's concerns and the medical issues into a concrete plan that can be carried out in the patient's system of health care. Outline a step-by-step plan, explain it to the patient, and contract about the next step. Be explicit about your next contact with the patient ("I'll see you in clinic in 2 weeks") or the fact that you won't see the patient ("I'm going to be rotating off service, so you will see Dr. Back in clinic"). Give the patient a phone number or a way to contact the relevant medical caregiver if something arises before the next planned contact.



4 (Excellent) 3(Good) 2(Good) 1(Bad)   


Recommended Books for PLAB Part 2
• Books to read for PLAB Part 2 by RxPG

Related PLAB Part 2 articles
• My experience with PLAB 2 !
• PLAB Part 2 OSCE stations in may 2009
• UK Mental Health Act - What You Should Know for Your OSCE
• My Experience in PLAB Part 2 OSCE Exam on June 28, 2006
• I cleared PLAB II on jan 30: My experience
• PLAB Part 2 Exam, A Mystery?
• My PLAB Part 2 OSCE Experience and Mistakes
• List of OSCE Stations in Past Six Months in PLAB Part 2
• Best Tips to Pass PLAB Part 2 Exam from my experience
• Things to Bring to UK While coming for PLAB Part 2
• Sharing My Experience of PLAB part 2 OSCE
• PLAB Part 2 OSCE – My Experience and Some Tips
• Important Changes in European Resuscitation Guidelines: A Must for PLAB takers
• PLAB Part 2 is not a difficult exam!!!
• How I Faced PLAB OSCE Stations in Real Exam
• Few Tips for the Mannikins OSCE Stations in PLAB Part 2 Exam
• I passed PLAB Part 2 OSCE Examination, my experience
• OSCE Stations in PLAB Part 2 by GMC on 11 oct 2005
• PLAB Part 2 OSCE - Exam experience on the day
• plab2 on 16th august in the morning

Related PLAB Part 2 Discussions

Other articles by tegs
• Huntington’s Disease
• List of themes for March 9, 2004 PLAB Part 1 Question Paper
• How to prepare for PLAB part 1?
• PLAB 1 Format Change from September 2004
• SGPGI MD Entrance Examination (January 4, 2004) Results
• Indian GP honoured with Lifetime Achievement Award
• Job Situation in UK - by Dr Suresh Chari
• Couinaud's nomenclature
• MRCS Degree will be awarded in India - DNB tie up eith Royal College of Surgeons
• Essential Information for UK Dentist Career
• H1-B route to US is a little easier
• JR/Demo AIIMS foreign/sponsored -RESULT 2004
• PGIMS December Results - Full List
• New Format of TRAS – Temporary Registration Assessment Scheme
• Essential Information - THE COUNTRY OF THE UNITED ARAB EMIRATES
• Why Work in Saudi Arabia?
• Medics Abroad Have to Sit Exams to Qualify for Work Visa in Saudi
• CBI arrests students in Ranchi for leaked papers
• After CAT, Ranjit's role in AIIMS paper leak being probed
• MAHE Admissions 2004

 PLAB Part 2 FAQ
  FAQ: Recent Changes in Passing Criteria for PLAB Part 2?
  FAQ: Best coaching for PLAB Part 2
  FAQ: Are 4 months preparation enough ?
  FAQ: How to examine the cranial nerves?
  Browse all FAQs


Write an Article on PLAB Part 2
You can share your exam experiences, preparation strategies, books you have read or just any information about PLAB Part 2 on RxPG website and we will publish it under your name.

Article Rating
Average Score: 4.2
Votes: 5




Most Read Article
My experience with PLAB 2 !

Related Links
· GMC Website
· British Council India
· *PLAB 2 Coaching
· Tube Map London
· PLAB 2 Forum
· Upper Limb Exam Video
· Shoulder Exam Video
· Chest Exam Video
· Abdomen Exam Video
· ENT Exam Video
· Lower Limb Exam Video
· Cardiac Exam Video
· Ophthal Exam Video
· Neuro Exam Video
· Sexual History Video
· Sexual Counseling Video






ARTICLE TOOLS

· PLAB Part 2 section
· Articles by tegs
· Add to my pages
· Printer friendly version
· PDF version
· Email article
· Feedback on this article
· Medical tutorials
· Related forum posts
· Related articles
· Related downloads
· Submit article
· PLAB Part 2 alerts
· PLAB Part 2 books
· PLAB Part 2 past papers


Most read story about PLAB Part 2:
My experience with PLAB 2 !



Server Status: 68 pages served in last minute. Page generation time: 0.142 seconds

Site Maps: [Books] [News] [Forums] [Reviews] [Mnemonics]

sitemap - top30 - centuries - testimonials


About Us :: Disclaimer :: Contact Us :: Reporting abuse :: Terms of Services :: Privacy Policy

Advertise with RxPG!
Made in India by RxPG Medical Solutions Private Limited

"RxPG" is a Registered Trademark

Chrome Web Store YouTube Twitter LinkedIn Wikipedia Facebook