Location: You are a junior doctor in the acute medical team
Patient: 25 year old homosexual male patient has been admitted to hospital shortness of breath and generally unwell. Found to have fever, lymphadenopathy and bilateral apical pneumonia. He has recently been abroad and has had multiple unprotected encounters with other men. Your consultant gained consent for a HIV test. The result has come back as HIV PCR positive. Your consultant is at an emergency and has asked you to discuss these results with the patient.
Task:
- Gather the reason for attendance
- Explain results of the HIV test
- Give appropriate advice on the long term plan for this patient
- Answer any questions the patient may have
Note to actor: Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers may be required.
You are a 25 year old male patient who has been admitted to hospital feeling really unwell with shortness of breath and generally not feeling well. You were told you had a nasty chest infection and for the last couple of days have been treated with IV antibiotics, you are actually feeling much better now. The consultant a couple of days ago said you needed a HIV test and you agreed to this.
You have recent been traveling in south east asia and have been to Vietnam, Thailand, Bali and Singapore. You had all of the vaccinations required by the travel clinic and you were extremely careful about what you ate and drank. You admit to having had multiple male sexual partners and did not use any protections as the locals did not like that. You were told by all your partners that they had recent sexual health tests which came back negative.
ICE before bad news broken
Ideas – you think you probably picked up a bug when you went traveling and you are feeling much better since the antibiotics
Concerns – that you have been in hospital for so long now
Expectations – that your most recent blood tests and imaging are looking better and hopefully you are ready for home soon.
PMH
Usually fit and well
DH
No regular medications
No known drug allergies
SH
You have never smoked
You drink socially
ICE after bad news broken
Ideas – you are sure the tests must be wrong and need repeating
Concerns – if the tests are correct that you are going to die young
After information is given you want to know:
- Can the test be wrong
- What is HIV
- Can HIV be cured
- Are you going to die young
- What is the longer term plan now? (i.e what specialists do i need to see)
- Can you continue to have sex?
Overall role = you are a very relaxed patient. You are not expecting the HIV test to come back negative, you think this is just an infection you picked up abroad. After the information is given you are very shocked, you go silent and you have to have everything pulled out of you. You avoid eye contact.
You do not understand any medical jargon and require it to be explained if said by the candidate. You need to give the candidate opportunity to break down this station, you are required to give very long pauses in order to make the station uncomfortable. Make use of non-verbal cues if appropriate to show both happiness and sadness e.g hands on face covering eyes, shaking of head, ect.
If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection.
