Psychosocial concerns

Possible stations

With a patient

• Concerned about a test

  • Try to find the underlying reasons for their concern

• Wants a sick note because of problems at work
• Wants to self-discharge because they need to care for a partner at home
• Wants to die
• Wants to lose weight because a relative died recently of obesity-related health problems
• Wants to make a complaint

  • Don’t forget to mention the patient advice and liaison service (PALS)
  • You can say you are sorry they feel that way/went through that but generally don’t apologise/admit guilt

• Feels another doctor examined them inappropriately/didn’t offer chaperone

With a patient’s relative

• Carer struggling

  • Social services can do a care assessment to provide money/respite/help
  • Charities (e.g. carersuk.org and carerssupport.org.uk) offer help and support groups
  • Health visitor for children
  • Stress they’re not alone

• Concerned about social care arrangements for elderly relative

  • Social services can arrange care
  • There are also private care organisations
  • In a crisis, doctors can refer to the rapid response team for short-term care

• Carer says patient has stopped taking their medication and wants to know how to make them take it
• Is concerned their relative may have cancer because they know someone else who had similar symptoms and then died of cancer

With a colleague (e.g. doctor, nurse, midwife, student, secretary, receptionist) 

• Another member of the team is not pulling their weight, is always late, makes mistakes, or smells of alcohol etc.

  • Options include speaking to the culprit directly (usually best initially), and then considering speaking to their senior (offer to be present)
  • If patients are/may be at risk, you must take action and inform a senior. You should tell the culprit you are doing so.

• Being bullied by another member of the team

  • Could they approach the perpetrator? Can they speak to their supervisor/senior/human resources? Offer to be present if possible.
  • If they have tried to resolve it but had no success, they may need to make a formal complaint
  • Screen for depression (but remember you are not their doctor and should direct them to their GP if needed)

• Issues at home affecting work
• A colleague who is stressed
• Shaken up by something that has happened (e.g. a patient died)

  • They will need ongoing support – can they speak to their supervisor or occupational health? Offer to be present if possible

• A colleague has made a mistake

  • Have a non-judgemental attitude
  • Emphasise the ‘no blame’ culture when mistakes are admitted
  • Incident reporting can help everyone learn so the same mistake doesn’t happen to others
  • Honesty is the best policy

• A health visitor concerned about a child abuse within a family without any evidence because he/she missed a similar problem previously

Aims of the station

• Be non-judgemental
• Empathise
• Listen!
• Pick up on cues and show you have heard them
• Address their ideas, concerns and expectations (ICE)
• Suggest possible solutions 

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Introduction

and build rapport

Tips

• Don’t be afraid of silence
• These stations can be difficult because there isn’t a goal like completing a history or explaining a test. Most patients just need a sympathetic ear and some guidance.
• There is often a hidden agenda that the patient will only disclose if you probe with ‘ICE-type’ questions, e.g. they may come in for a sick note but actually they are being bullied at work
• Use the patient’s name and show empathy
• Respond to cues! It is important to concentrate on what the patient is saying. Don’t distract yourself worrying further questions.
  • Cues may be verbal or non-verbal
  • Comment on it, e.g. ‘You look worried.’
  • After recognising a cue, repeat it back to the patient and then ask more about it (e.g. ‘You mentioned that sometimes you feel down – can you tell me more about that?’)
• Don’t treat a colleague like a patient – chat informally if you ‘know them’ and listen sympathetically. But if there’s a medical problem, you cannot treat them – you need to advise them to see their own GP.
• It is not your job to solve their problem – just listen and suggest possible ways to address it. If you don’t know of any services that could help them, say you will look into it and arrange to meet them again to discuss further.
• If you need to involve somebody else (e.g. their supervisor/manager), ask the patient/colleague/carer if it would help if you were present too