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Clinical Skills Assessment Medical OSCE Exam (OSCE home)

Difficult Patients' OSCEs Scenarios

 

How To Unlock Difficult Medical Encounters in OSCEsIsn't it awful and stressful to be the weak side when facing a 'difficult angry patient'?

How many times you were felt hurt and failed?

"How To Unlock Difficult Medical Encounters"

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Download a sample version


'Difficult Patient' OSCE Scenarios 

Common 'Difficult Patient' topics in Objective Structured Clinical Examinations

The common topics that have been tested in OSCE exams during USMLE Step 2 CS, MCCQE Part II, PLAB 2, OSCEs for medical students and medical school clinical finals, Clinical Skills Assessment for International Medical Graduates are:

 

'Difficult Patients' in OSCEs

  • The Silent or Reticent patient.
  • The Rambling or Talkative patient.
  • The Vague patient.
  • The Angry patient.
  • The Depressed or Sad patient.
  • The Denial patient.
  • The Anxious patient.
  • Patient with Somatization.
  • The Dependent and Demanding patient.
  • The Dramatic or Manipulative patient.
  • The Long Suffering, Masochistic patient.
  • The Orderly and Controlled patient.
  • The Manic, Restless patient.
  • The Guarded Paranoid patient.
  • The Superior patient.
  • Breaking bad news.
  • Caring for the dying patient.
  • Conflicted Roles.
  • Solving Conflicts.

 

 


Screaming Difficult OSCE Exam

 

Common 'Difficult Patient' OSCEs 

 

Common 'Difficult Patient' OSCEs cases that have been seen in OSCEs during USMLE Step 2 CS, MCCQE Part II, PLAB 2, OSCEs for medical students and medical school clinical finals, Clinical Skills Assessment for International Medical Graduates are:

 

 

  1. Elizabeth Noseworthy is a 58 years old diabetic patient who was brought to the emergency by her husband, Jack Noseworthy, unconscious. Your colleague told you that she had been received dead and they failed to resuscitate her. Please talk to Mr Northsworthy in the next 5/10/15 minutes. (Breaking bad news/ in this scenario you will discover that the cause of death was an extra insulin shoot given by the husband when he found his wife unconscious assuming that she ate too much at the party that night. As you tell him the bad news, he turns very upset and restless blaming him self for killing his wife).

  2. Joan Lavis is the mother of your 17 year old patient, Sandra Lavis, she came to your office asking to see you. Please talk to her in the next 5/ 10/15 minutes. (Confidentiality/ Demanding/ in this scenario you will discover that the mother found an appointment card in her daughter pocket while doing the laundry. She demands and insists to know the reason of her daughter's visit. Note: no reason was given for the visit in the stem question).

  3. George Baclham is 32 year old man who came to your office for the first time. Please talk to him in the next 5/ 10/15 minutes. (Drug seeker/ in this scenario you will discover that he is out of town and has headache. His doctor prescribed a pain killer with codeine and wants you to prescribe it again. He interrupts you repeatedly and rudely during your history taking telling you that his doctor had already asked him these questions and there is no point to repeat the process. Note: no reason was given for the visit in the stem question).

  4. Jonathan Simons is 26 year old man who was brought by the police to the emergency after his wife claimed that he attempted to kill her. You are the physician on duty today. Please talk to him in the next 5/ 10/15 minutes. (Acute psychosis/  in this scenario you will discover that the patient is agitated restless pacing the room and refuses to sit down to talk).

  5. Anthony Rochester is 32 year old business man came to your office because his wife insisted that he should see you. Please talk to him in the next 5/ 10/15 minutes. (Mania/  in this scenario you will discover that the patient is restless pacing the room and refuses to sit down to talk, full of joy and happy and don't want to discuss that being so happy is an illness. Note: no reason was given for the visit in the stem question).

  6. Jane Smith is 53 year old woman who came to your office complaining from left upper quadrant pain. In the next 5/ 10/15 minutes take focused history and discuss a plan. (Somatization/ Talkative/ in this scenario you will discover that the patient keeps talking and don't let you ask her questions or be in control of the interview) .

  7. Marie Price is 57 year old came to your office because her husband insisted that she should see you. Please talk to her in the next 5/ 10/15 minutes. (depression/  in this scenario you will discover that the patient is says almost nothing and doesn't know why she is here. Note: no reason was given for the visit in the stem question).

  8. Lucy Armstrong is 23 year old woman who came to your office after she felt a lump in her right side of her upper neck. In the next 10/15 minutes take a focused history and perform a focused physical exam. (Note: She keeps her bra and thighs exposed with gestures of seduction and may ask if you are free tonight (even if your are a female doctor). The case is infectious mononucleosis and she is sexually active. Take sexual history and safe sex counselling too.) (Lymphadenopathy/ Seduction/  Safe sex).


 

Dealing with 'Difficult Patients':Difficult OSCEs - Sad Depressed

In real medical practice, dealing with 'difficult patients' are seen almost daily. 'Difficult patients' are ordinary people who come to your health institute, whatever is that, because they have to, not because they want to. Sometimes, they have even been brought in unwillingly by a family member or a friend. They come in with their vast range of different personalities, cultural background, and current emotional state. 

Being in a health care facility adds more worries and stresses due to lost time, expenses, and more importantly losing control. People are usually in control of what they have to do now, well at least they think so. But on the moment they put their feet in front of your registration desk, they lose this control. We, the strangers, take control!... We give instructions and orders to follow starting right from that registration desk... Give me your ID, .. insurance,.. wait there,.. sit there,.. you have to wait,.. take off your cloths,.. touching them, .. etc. 

So, by the time of their medical encounter with us, the physicians, they are already up on the edge in their stress and comfort levels. And guess what, we as the highest ranking authority here and thus have to receive all the blame and deal with them in these 'difficult patient' situations. Although, some of these people will look like trouble makers by personality, most of the exaggeration is due to the building up stress and worry, or simply part of their illness! 

Dealing with 'difficult patients' in medical encounters needs a lot of communication skills to sooth them and calm them down or to let them at ease and open for effective communication. However, although this is part of our duty in addition to establishing rapport and friendly environment, it is not our goal in medical encounters! We are not social workers. Our goal is to figure out what is going wrong with them physically and psychologically in order to help them. These good communication skills are not the goal, they are wonderful magical means to achieve our goal, the patient well being. Communication skills are our vehicle to take a thorough medical history, perform accurate safe physical examination, and assure patient compliance, and yet efficiently in respect to our time and resources limits. 

As you may realize now, it is important to learn the specific communication skills to deal with these 'difficult patients' in real life. This will make us friendly caring clever doctors and build a good reputation while staying thorough, focused, organized, and efficient. This is what successful considerate physician know very well!

 


'Difficult Patient' OSCEs:Difficult OSCEs - Angry

As Objective Structured Clinical Examination stations (OSCEs) are simulation of real life medical encounters. 'Difficult to deal with patient' scenarios will be also seen in these exams. These difficult behaviours will be seen either embedded as a short part of the station scenario or as a full station by itself.

We need to prepare ourselves to these 'difficult patient' OSCEs because we will be assessed mainly for our communication skills in these OSCE exam stations. These OSCE Exams need a lot of empathy too but be careful don't act as a social worker. Act as an attending caring efficient physician and use the communication skills as a mean, not as a goal.

 


Now how to improve your way of dealing with each of these 'difficult patient' OSCEs? 

 

 

Ask yourself:

What would I do if my OSCE standardized patient (SP) was angry and threatening me? Is what am I doing with this difficult patient correct ethically? Dose it serve me well? Dose it resolve the situation?  How to improve my way of doing that?...

What would I do if my OSCE SP was a depressed woman who refuses to talk? Again, is what am I doing with this difficult patient correct ethically? Dose it serve me well? Dose it resolve the situation?  How to improve my way of doing that?...

What would I do if my OSCE SP was a restless young man who kept pacing the room refusing to calm down and sit to talk? ...

What would I do if my OSCE SP was a talkative middle aged woman who kept telling me her stories wasting my valuable exam time? ...

What would I do if my OSCE SP was a teenage boy or girl who wants me to go out with him/her for a date? ...

What would I do if my OSCE SP was an HIV positive man who refuses to inform his wife about his illness? ...

What would I do if my OSCE SP was a sixteen year old boy with history of epilepsy and insisting to have a letter to the driving license authority? ...

What if?....... & what if?....... & what if?............


Check our ebook for how to deal with 20 'difficult patients' scenarios!

"How To Unlock Difficult Medical Encounters"

How To Unlock Difficult Medical Encounters in OSCEs

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Do you want to be distinguished? 

"How To Unlock Difficult Medical Encounters" is an ebook that helps you recognize and deal with 'difficult patient' medical interviews and issues. It provides proven steps to follow to unlock 'Sick encounters'!. Short, condensed, well organized and easy to read and memorize.

Almost every day, you, medical students, residents, and physician face 'Difficult Patients' in your clinical practice. All OSCE organizers, like USMLE, MCC, GMC, and medical schools, include difficult to deal with patient scenarios in their exams to test your communication skills and reactions.

Limited resources are out there to help you deal with these 'Difficult Patients'. Most of these resources deal with the etiology behind these situations hoping that the understanding of the etiologies will help you to figure out the right ways to deal with them!

Learning to take medical history or perform a physical exam is easy. You will be amazed how well your colleagues is doing with these clinical tasks. There are tons of resources to train yourself these skills. But what about communication skills with 'difficult patients'? You will be amazed how bad your colleagues is doing with these clinical tasks that need special communication skills!.. Imaging yourself mastering these skills!.. Definitely, you will be distinguished form the crowd!... Your colleagues will ask your help to teach them your secrets to master these situations!... Nurses will recommend that you, the expert with a human touch, to deal with such situations!.. Your OSCE examiner or clinical supervisor will admire you. 

This is the first ebook that is written focusing on techniques, strategies, and practical proven steps to help you deal with 'Difficult Patients'. It is focused on practical tools ready to learn, adopt, and  implement to improve your way of dealing with difficult patients in both OSCE exam scenarios and real life settings. 

You have no time to read and you need to learn quickly proven skills. You can download and start studying it now! 

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