Ms Wurzel is a 60–year-old alcoholic who has presented to hospital with a chronic cough. Investigations have confirmed she has active pulmonary tuberculosis. She is due to start treatment today, but your consultant has asked you to explain that she needs to remain in hospital for her treatment as she has no fixed abode. She is in a side ward on the Acute Medical Unit.
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A good candidate will introduce themselves and establish the reasons for the consultation. The candidate will explore the patient’s current ideas about their diabetes. Explore their concerns about using insulin and why they may not be adherent. The candidate should explore the impact diabetes has on the patient’s life, including driving, alcohol, education/work. The candidate would be expected to give some basic insulin counselling, explaining that there are different options available to manage diabetes. The candidate should explain the importance of insulin in the short term (DKA) and the long term (neuro, vascular complications). A good candidate will arrange follow-up with the Diabetes Specialist Nurse.
This patient is currently actively withdrawing from alcohol and the candidate correctly identifies her symptoms are due to this rather than the tuberculosis. He explores her symptoms regarding her alcohol intake and duration of her symptoms to establish a rapport before exploring the current issues. It is clear that the patient’s home circumstances are not ideal and, together with her drinking, the candidate quite rightly identifies these maybe major risk factors for noncompliance. The candidate has to persuade the patient to stay and he uses a number of ways. Firstly, he suggests her current symptoms of alcohol withdrawal can be addressed better and that the drugs and alcohol team can give her some support. He also outlines the fact that she is infectious at the moment and would put other people at risk of contracting tuberculosis. He also suggests that without treatment for tuberculosis, there may be long-term risks that can affect her breathing. He was realistic, however, about what he may be able to offer with respect to moving wards and said that this would be unlikely. In this scenario, the patient seemed to take these issues on board, but if the patient was still insistent on leaving, then the issues of autonomy and public safety would need to be tackled. The candidate suggested he could not force her to stay but, actually, if she was highly infectious and a public health risk, then she could potentially be detained against her will to protect the public interest. She could not of course be treated against her will if she has capacity and refuses treatment. This can only be done if the patient lacks capacity or is detained in certain circumstances under the Mental Health Act and only certain treatments would be allowed in these circumstances. In this difficult scenario, the candidate would clearly involve his seniors and perhaps the hospital legal team. The candidate summarised the situation well at the end and there was a clear plan going forward.
Persuading a patient to remain in the hospital - actor roleplay.pdf
Persuading a patient to remain in the hospital - candidate roleplay.pdf
Persuading a patient to remain in the hospital - keyword and phrases.pdf
Persuading a patient to remain in the hospital - examiner roleplay.pdf