Location: You are a junior doctor on medical ward cover. You have been called by the nursing team to come explain the results of a patients CT scan that has now been reported. He is very anxious and does not want to wait until the day team comes in tomorrow.
Patient: 55 year old has been admitted with a cough and has been coughing up bits of blood for the past six months, has had a chest x-ray in A&E and as a consequence a CT scan.
CT scan report = large upper mass in the right lung with 6 smaller lesions throughout the lung. There is evidence of underlying emphysema. There is lymphadenopathy present in the lungs. There is evidence of metastasis present in bone, liver and adrenal glands. Probable advanced primary lung cancer with metastatic spread. Recommend lung MDT input.
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 in hospital by yourself, your partner is at home and you do not want to worry them by calling them into hospital until you know what is going on.
You are a 55 year old patient who has come into hospital because you have had a cough, bringing up specs of red in your phlegm over the past 6 months. You were not particularly worried about this but your partner has been, so you went to the GP and he sent you immediately to the hospital for a chest x-ray. You have lost a lot of weight, have no appetite and have very little energy. If asked you have smoked 40 a day for the past 40 years. Otherwise you are fit and well.
You had a CT scan earlier on today to “exclude” cancer as the doctors in A&E had seen something unusual on the chest x-ray. You are worried what this could be and you hope this is not lung cancer.
Your bother died of lung cancer just over a year ago. He had a lot of treatment that made him very sick and he passed away very quickly after being diagnosed. You are worried that the same thing will happen to you.
You still work as a self employed builder and are the sole provider for your partner. You are concerned that you wont be able to continue working and how will you be able to provide for yourself and your partner.
Overall role = you are a concerned patient, you need everything explaining. You do not understand any medical jargon and require it to be explained if said by the candidate. You need to specifically know what the CT scan shows, a “mass” is not enough, the focus of this station for you is to know if this is cancer or not. 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 to show you are upset 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.