You are a doctor in a Medical Outpatient Clinic. You are reviewing a 35-year-old man following discharge from an admission 2 weeks ago following a blackout. There is a witness that stated that he had some kind of jerking movements when he lost consciousness. You now have the results of his investigations. All the investigations including brain scan and cardiac investigations are normal, but his EEG is in keeping with epilepsy. You must not take a detailed history except for confirming the events. You have to explain the results of his investigations, discuss potential treatment and explain lifestyle risks including driving
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The ideal candidate needs to be empathetic to the patient, to discuss the risks of further seizures, the risk/benefits of drug therapy and the law in relation to driving. The candidate should be asked to identify the ethical and/or legal issues raised in this case and how they would address them.
The framework for discussion should include consideration of these four underlying principals: • respect the patient's autonomy • duty to do good • duty to do no harm • legal aspects (a detailed knowledge of medical law is not required).
The candidate should recognise his/her limit in dealing with a problem and know when, and from where, to seek further advice and support.
Epilepsy is a relatively common theme to occur in the Communication Skills of the PACES examination. Important themes to be aware of in Communication Skills in general do include reasonable knowledge of DVLA restrictions on driving for certain medical conditions, with epilepsy most likely being the number one condition that you should have a reasonably thorough knowledge of the potential restrictions. Here it was important to note that the patient had an abnormal EEG and therefore required a 12- month driving ban as a minimum. If an EEG had been normal, a 6-month ban from his last fit should he remain seizure-free would suffice. Other conditions to familiarize yourself with regards to driving regulations would include obstructive sleep apnoea, hypopnea syndrome, diabetes, in particular patients that have had severe hypoglycaemia and cardiology diagnoses such as myocardial infarction, with percutaneous coronary intervention, and patients with implantable cardiac defibrillators. If this patient had been female, another theme that could have been explored would have been the effect of epilepsy on future or current pregnancy, i.e. the potential teratogenic effect that some anti-epileptic medications can have. It would be important to explore with any female patient in a station such as this, their current and future plans to have children and to ensure that while on any anti-epileptic medication, they should be on full contraception and all pregnancies should be pre-planned and discussed with their physician wherever possible.
Informing DVLA - Examiner role play.pdf
Informing DVLA - actor role play.pdf