ABSTRACT
KEY With situations like this, both in the OSCE and in reality, it is well worth asking the patient at the outset what his or her main concerns are and what he/she wishes to know. This will enable you to focus your discussion on the patient’s needs, increasing his/her satisfaction and saving you time. If, for example, the patient’s main concern is pain, you should focus your discussion on analgesia, only briefly covering other aspects as required. It is also worth clarifying what his/her current understanding is so that you pitch your discussion at an appropriate level. You may find, on the one hand, that your patient is unclear about what operation he or she is having or, on the other, that he/she wishes to discuss exactly which anaesthetic agent will be used. The role-players in the OSCE are there to help you, and if you give them the opportunity, they will help direct your discussion to enable you to gain the most marks. Your ‘patient’ may have been armed with a particular concern, for example having to see the operation whilst under epidural anaesthesia, and the mark scheme will include points for eliciting and addressing that concern. Be courteous and polite, establish rapport and ask the ‘patient’ during the conversation if there is anything else he/she wishes to know about or discuss. The main tip here is to follow the role-player’s agenda not your own. In this scenario, Mrs Smith wishes to have an overall explanation of what will happen, as she has never had an operation before, and is also particularly concerned about being in pain and developing a deep vein thrombosis.
