You are doing your ward round on the Cardiology Ward. The nurse asks you to talk to Mr Jones. He has been admitted with an anterior myocardial infarction, which was managed by primary angioplasty. He is keen to go home but is concerned about all the new medications he has been prescribed.
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Information giving should adhere to the SPIKES model: • Setting • Patients perceptions (understanding of the diagnosis) to elicit ideas, concerns and expectations at this point • Invitation to receive information • give Knowledge (Chunk and Check) • address patient’s Emotions • Strategy and summarise o a good candidate will arrange a follow-up plan.
Good candidates will explore the psychosocial impact of the diagnosis. In other words, the effect the diagnosis has on the lifestyle of the patient (driving, sexual intercourse, etc). Candidates will be expected to understand DVLA requirements following a heart attack, as well as simple lifestyle advice (e.g. when it is safe to have sexual intercourse).
This was a good demonstration of communication. The observation felt like a conversation rather than a very didactic delivery of information. The patient's concerns here are paramount and they were ascertained early and dealt with in a very structured way. Both the mechanism of how a heart attack happens and the mechanism of action of the individual drugs were explained in a very non-jargon lay person's language.
At various points, the candidate gained acknowledgement that the patient understood. He was realistic about the fact that the majority of the medications were lifelong; however, there may be some dual antiplatelet therapy which is rationalised after 12 months following stent placement. This scenario involved having some knowledge of the DLVA guidance on driving, as many of the communication encounters do. It is worth looking at the common conditions that may arise in the communication encounters such as myocardial infarction, cerebrovascular disease, epilepsy and obstructive sleep apnoea and reviewing the DVLA website so that you have some of the knowledge required. Whilst it is OK to say you will refer to the guidelines, some basic knowledge will look professional. The candidate used summaries well and this can be used at different intervals when imparting a lot of information, allowing a steady build-up or layering of information. The important aspects of cardiac rehab, diet, smoking, and secondary prevention medication was handled well. Exertion post MI and sexual activity was raised by the patient and answered well by the candidate.
Councilling after heart attack - keyword and phrases.pdf
Councilling after heart attack - actor roleplay.pdf