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Communication Station 3
You are a physician associate working in a GP setting. You have two minutes to read the information sheet provided. Using the information, proceed to explain to the patient about their new diagnosis of acid reflux.
‘’When acid from the stomach leaks up into the gullet (oesophagus), the condition is known as acid reflux. This may cause heartburn and other symptoms. A medicine which reduces the amount of acid made in your stomach is a common treatment and usually works well. Some people take short courses of medication when symptoms flare up. Some people need long-term daily medication to keep symptoms away.
What are reflux and oesophagitis?
Acid reflux means that some acid leaks up (refluxes) into the gullet (oesophagus).
Oesophagitis means inflammation of the lining of the oesophagus. Most cases of oesophagitis are due to reflux of stomach acid which irritates the inside lining of the oesophagus.
Gastro-oesophageal reflux disease (GORD)
This is a general term which describes the range of situations - acid reflux, with or without oesophagitis and symptoms.
What are the symptoms of acid reflux and oesophagitis?
Heartburn: this is the main symptom. This is a burning feeling which rises from the upper tummy (abdomen) or lower chest up towards the neck. (It is confusing, as it has nothing to do with the heart!). Other common symptoms: these include pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, belching, indigestion (dyspepsia) and a burning pain when you swallow hot drinks. Like heartburn, these symptoms tend to come and go and tend to be worse after a meal.
Some uncommon symptoms include a persistent cough and chest pain
What causes acid reflux and whom does it affect?
The circular band of muscle (sphincter) at the bottom of the gullet (oesophagus) normally prevents acid leaking up (reflux). Problems occur if the sphincter does not work very well.
What tests might be done?
Tests are not usually necessary if you have typical symptoms. Tests may be advised if symptoms are severe, or do not improve with treatment, or are not typical of GORD.
Gastroscopy (endoscopy) is the common test. A thin, flexible telescope is passed down the oesophagus into the stomach.
What can I do to help with symptoms?
Stop smoking
Weight Loss
Avoid aggravating foods eg. Spicy foods/caffeine
Avoid lying down after food/late meals
What are the treatments for acid reflux and oesophagitis?
Acid-suppressing medicines - If you have symptoms frequently then see a doctor. An acid-suppressing medicine will usually be advised.
Surgery may be an option for some people whose quality of life remains significantly affected by their condition and where treatment with medicines is not working well
Are there any complications from oesophagitis?
Scarring and narrowing (stricture).
Your risk of developing cancer of the oesophagus is slightly increased compared to the normal risk if you have long-term acid reflux.
It has to be stressed that most people with reflux do not develop any of these complications’’.
(Adapted from: https://patient.info/health/acid-reflux-and-oesophagitis)
What are reflux and oesophagitis?
Acid reflux means that some acid leaks up (refluxes) into the gullet (oesophagus).
Oesophagitis means inflammation of the lining of the oesophagus. Most cases of oesophagitis are due to reflux of stomach acid which irritates the inside lining of the oesophagus.
Gastro-oesophageal reflux disease (GORD)
This is a general term which describes the range of situations - acid reflux, with or without oesophagitis and symptoms.
What are the symptoms of acid reflux and oesophagitis?
Heartburn: this is the main symptom. This is a burning feeling which rises from the upper tummy (abdomen) or lower chest up towards the neck. (It is confusing, as it has nothing to do with the heart!). Other common symptoms: these include pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, belching, indigestion (dyspepsia) and a burning pain when you swallow hot drinks. Like heartburn, these symptoms tend to come and go and tend to be worse after a meal.
Some uncommon symptoms include a persistent cough and chest pain
What causes acid reflux and whom does it affect?
The circular band of muscle (sphincter) at the bottom of the gullet (oesophagus) normally prevents acid leaking up (reflux). Problems occur if the sphincter does not work very well.
What tests might be done?
Tests are not usually necessary if you have typical symptoms. Tests may be advised if symptoms are severe, or do not improve with treatment, or are not typical of GORD.
Gastroscopy (endoscopy) is the common test. A thin, flexible telescope is passed down the oesophagus into the stomach.
What can I do to help with symptoms?
Stop smoking
Weight Loss
Avoid aggravating foods eg. Spicy foods/caffeine
Avoid lying down after food/late meals
What are the treatments for acid reflux and oesophagitis?
Acid-suppressing medicines - If you have symptoms frequently then see a doctor. An acid-suppressing medicine will usually be advised.
Surgery may be an option for some people whose quality of life remains significantly affected by their condition and where treatment with medicines is not working well
Are there any complications from oesophagitis?
Scarring and narrowing (stricture).
Your risk of developing cancer of the oesophagus is slightly increased compared to the normal risk if you have long-term acid reflux.
It has to be stressed that most people with reflux do not develop any of these complications’’.
(Adapted from: https://patient.info/health/acid-reflux-and-oesophagitis)
The distinction between average and excellent students is an understanding of what this task is testing. Average students often mistake this task as a test of knowledge, whereas this task is primarily a test of communication, assessing one’s ability to bridge the asymmetric information and knowledge between a doctor and a lay (non-medical) individual.
Average Candidate Response
Acid reflux is when acid leaks from your stomach into your gullet. It requires medication to reduce the amount of acid in your stomach. Investigations include a gastroscopy and if not managed appropriately, it can lead to cancer.
Acid reflux is when acid leaks from your stomach into your gullet. It requires medication to reduce the amount of acid in your stomach. Investigations include a gastroscopy and if not managed appropriately, it can lead to cancer.
Excellent Candidate Response
Introduction
State the end objective(s)
Establish baseline knowledge/understanding (So that I don’t repeat what you already know, what do you understand about…………..?)
Hello Mr/s…………, my name is……………………..and I am a physician associate in the GP practice. I understand that you have been diagnosed with acid reflux, is that correct? Over the next few minutes, I hope to discuss with you about what acid reflux is, how it can present, its causes, the possible management as well as complications if not effectively managed. Before I do that, I just wanted to establish what you already know about acid reflux so that I am not repeating information already known to you.
Define any relevant terms
Empower the patient to ask questions (eg. Do you have any questions at the moment? If you have any questions at any time, feel free to interrupt me)
If at any point you have any questions, feel free to interrupt me. To start with, acid reflux simply means when acid from the stomach ascends into the oesophagus or ‘food pipe’.
Provide clear, specific information
The symptoms of acid reflux can vary from heartburn which is often described as a burning feeling in the lower chest to severe chest pain or a persistent cough. With regards to causes of acid reflux, there are many different causes and often it is not possible to identify the exact cause. Do you have any questions before we discuss how we can investigate and manage acid reflux as well as its possible complications?
Acid reflux does not normally require investigation, however in severe cases investigations such as a gastroscopy which is a type of camera test, may be done. Other investigations include chest x-rays and heart tracings to exclude other conditions.
Acid reflux can be treated with lifestyle changes, for example stopping smoking, losing weight and avoiding spicy or caffeinated foods. If these measures aren’t sufficient, we can consider medication such as ant-acids to relieve symptoms.
In the event that we do not successfully manage your acid reflux, there is an increased risk of complications such as strictures or narrowing of the food pipe and possible cancer of the oesophagus and hence so it is very important to address this.
I appreciate that we have discussed quite a lot today; do you have any questions?
Summary and plan going forward
Just to summarise what we have discussed, acid reflux is when stomach acid leaks into the food pipe. The symptoms can range from heartburn to severe chest pain with investigations not usually required. Acid reflux can be managed through a combination of lifestyle changes as well as medication. If acid reflux is not managed appropriately, it can lead to a number of complications.
If you would like, I can provide you with a patient information leaflet on acid reflux, and then if you still have questions at a later stage, feel free to make a follow up appointment so that we can discuss these further.
Introduction
State the end objective(s)
Establish baseline knowledge/understanding (So that I don’t repeat what you already know, what do you understand about…………..?)
Hello Mr/s…………, my name is……………………..and I am a physician associate in the GP practice. I understand that you have been diagnosed with acid reflux, is that correct? Over the next few minutes, I hope to discuss with you about what acid reflux is, how it can present, its causes, the possible management as well as complications if not effectively managed. Before I do that, I just wanted to establish what you already know about acid reflux so that I am not repeating information already known to you.
Define any relevant terms
Empower the patient to ask questions (eg. Do you have any questions at the moment? If you have any questions at any time, feel free to interrupt me)
If at any point you have any questions, feel free to interrupt me. To start with, acid reflux simply means when acid from the stomach ascends into the oesophagus or ‘food pipe’.
Provide clear, specific information
The symptoms of acid reflux can vary from heartburn which is often described as a burning feeling in the lower chest to severe chest pain or a persistent cough. With regards to causes of acid reflux, there are many different causes and often it is not possible to identify the exact cause. Do you have any questions before we discuss how we can investigate and manage acid reflux as well as its possible complications?
Acid reflux does not normally require investigation, however in severe cases investigations such as a gastroscopy which is a type of camera test, may be done. Other investigations include chest x-rays and heart tracings to exclude other conditions.
Acid reflux can be treated with lifestyle changes, for example stopping smoking, losing weight and avoiding spicy or caffeinated foods. If these measures aren’t sufficient, we can consider medication such as ant-acids to relieve symptoms.
In the event that we do not successfully manage your acid reflux, there is an increased risk of complications such as strictures or narrowing of the food pipe and possible cancer of the oesophagus and hence so it is very important to address this.
I appreciate that we have discussed quite a lot today; do you have any questions?
Summary and plan going forward
Just to summarise what we have discussed, acid reflux is when stomach acid leaks into the food pipe. The symptoms can range from heartburn to severe chest pain with investigations not usually required. Acid reflux can be managed through a combination of lifestyle changes as well as medication. If acid reflux is not managed appropriately, it can lead to a number of complications.
If you would like, I can provide you with a patient information leaflet on acid reflux, and then if you still have questions at a later stage, feel free to make a follow up appointment so that we can discuss these further.