GP Stage 3 Simulated Consultation - Patient 4
You are an FY2 working in a GP surgery and your next patient is Mrs Lindhoff, 63. She has attended to discuss the results of her recent skin biopsy, the summary report of which is as follows:
‘Invasive malignant melanoma with clear cell features. Breslow depth 6mm.’
Reference Information (British Association of Dermatologists): Breslow Depth >4mm = 50% Approximate 5 Year Survival
You are Mrs Lindhoff, a 63 year old retired lady who had a skin biopsy taken from your left arm recently. You have attended the GP surgery to discuss the results.
You suspect that the lesion may be cancerous, especially with a friend of yours having a similar lesion and being diagnosed with skin cancer. You have limited medical background knowledge, and are pleased to hear that the diagnosis is not cancer, for candidates using the medical term ‘Malignant Melanoma’ (This is a form of advanced skin cancer).
You are distraught to hear the diagnosis (if directly advised that you have cancer), and require significant consoling. In particular, you are not sure how you will cope at home (previously independent, living alone at home), and how the cancer will affect the rest of your body. You also would like to know what the next step is, as well as the prognosis.
This consultation tests a candidates ability to break bad news as well as provide necessary information, in a jargon-free manner. Candidates require a sensitive, yet focussed approach providing the diagnosis in a clear manner, as well as providing appropriate emotional support thereafter. Despite the ‘reference’ information provided, it is essential for candidates to demonstrate an understanding of their limitations and seek to involve senior/specialist input rather than providing specific detailed information regarding prognosis and on-going management, given that this is generally patient specific.
S – Setting up the interview (preparing yourself and the consultation setting)
P – Perception (Understanding the patient's perception of their condition and it's seriousness)
I – Invitation (Wait for the patient to invite you to deliver the bad news)
K – Knowledge (Knowledge and information transfer to the patient)
E – Empathy and emotional support
S – Summary and strategy for the future