Examples of rote behaviour to avoid
Examiners are looking for real interaction with the simulated patient. This means candidates asking questions that patients can understand, listening to patients and responding clearly and sensitively.
Sometimes candidates appear to be using stock phrases, which they may have learnt on courses and are just copying. These can sound out of place, insincere and odd if just copied routinely. If the examiner thinks you are using such rote behaviour without interacting with the patient in front of you, you can lose marks for interaction.
You are expected to deal with the patient exactly as you would if you were the junior doctor seeing her or him in clinic. The clinical situations in the stations are designed to be within the capability of a junior doctor.
Examples of rote behaviour to avoid.
1. ‘Everything you tell me will be kept confidential.’
While medical students who talk to patients for their own learning benefit are taught that they must explain ‘everything you say will be kept confidential within the medical team’, patients can assume that doctors will keep details of the consultation confidential. You therefore do not need to say this, and indeed it could sound odd to a patient. There may however be particular circumstances where it would be appropriate to say this. For example, if a patient is worried about telling you something and you think this is because of confidentiality.
2. ‘May I ask you a personal question?’
Signposting when you are changing the line of questioning can sometimes be helpful; for example when moving from asking about symptoms to lifestyle habits. ‘I’d like to ask you about lifestyle habits’. However asking ‘May I ask you a personal question?’ followed by questions such as ‘Do you drink alcohol?’ or ‘Do you smoke?’ can seem odd. Because many adults in the UK drink alcohol and about 10 million smoke you could be seen to be implying it is something to be embarrassed about by highlighting it as ‘personal’. If you think the patient was offended by a question, then apologise and explain that you are asking to help get a clear understanding.
3.‘ May I ask you some questions?’, ‘Is that OK?’
As in real life, you can assume that patients (unless detained under the Mental Health Act) have sought the consultation with you. They will expect a doctor to ask questions and they will generally wish to be cooperative. In routine consultations expressions such as ‘May I ask you some questions?’ or adding ‘Is that OK?’ to statements can sound odd coming from a doctor.
It is however appropriate when examining a patient to say ‘I would like to examine you, is that OK?’ to check implied consent before proceeding.
Additional advice:
4. If a child is being discussed, ensure you get the sex of the child right and use the correct pronoun, he or she. The instructions will tell you if this is a male or female child.
If the child is not a baby, do not refer to it as ‘baby’. The instructions will tell you if this is a baby or child.
5. You will be given instructions on how to explain what you are doing when examining a manikin. Unless it says to do so, do not talk to a manikin.