Ms Bailey was recently admitted with a new-onset tachyarrhythmia (narrow complex). She was successfully cardioverted with amiodarone (after adenosine and metoprolol were tried). Her sinus rhythm resting ECG now shows clear evidence of Wolf–Parkinson– White syndrome. Her echocardiogram revealed no structural abnormalities. The plan for her management will be to continue oral amiodarone to prevent further episodes of arrhythmia until electrophysiological studies of the heart (with or without ablation of accessory pathway(s)) can be arranged. This has an 80–90% chance of cure and a 0.2% chance of stroke or death. Please explain this to her.
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The candidate must convey the following points:
This scenario involves a discussion of the diagnosis of Wolff-Parkinson-White syndrome, its potential management options, and any risks and benefits of these. This is predominantly a test of the candidate’s communication skills, rather than medical knowledge. A clear plan of action that needs to be explained is given in the candidate information for this station. This is NOT an in-depth test of your knowledge of cardiac electrophysiology and the intricacies of ablation procedures. This station requires the candidate to break down a complex diagnosis and management plan into terms that the patient can understand. This will involve explaining the diagnosis itself, and the risks of leaving the patient untreated. Moving on from this, a good candidate will be able to explain the procedure itself, and its benefits and risks in a step-wise fashion that the patient can understand and allow time for discussion and questions. When faced with a scenario where you must explain the diagnosis and procedure, you may well find that there are not a huge number of ethical issues that have arisen from the case. Make sure you are fully aware of how capacity is defined. You also need to know what comprises informal, and fully informed formal consent, and what kind of risks should be explained to a patient. In this scenario, it is now deemed very important to explain even very low-risk complications to a patient if they are very serious.
Wolf Parkinson White syndrome - examiner role play.pdf