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USMLE Step 2 CS SP Challenges Challenging situations presented by the Standardized Patient (SP) during the the USMLE Step 2 CS Encounter.

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Old 08-10-2011
chulady's Avatar
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Unhappy Breaking Bad News to the Patient


Anyone, I just finished practice cases and opend kaplan notes to look through and found out that there is case for breaking bad news.
Examinee task as follow:

Tell the patient he has colon cancer
There is no history or examination in this case
There is no note in this case.

In that case, I do not need to do physical examination. Do i still need to enter patient's note in the computer or not ?

Please need advice.
My exam will be in 4 days.

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Old 08-10-2011
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I've never heard of this situation...
Since there's no history, i wouldn't know what to do too.
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Old 04-06-2012
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How do we deal with this?
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Old 04-08-2012
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This is an interesting situation. I don't know if you can get a scenario like this in the CS exam, but the following information I am posting can also be used for any sort of bad news that you may have to give the patient in a CS case.

What I would do is use the SPIKES protocol (this is actually also in 1-2 questions in UWorld for CK)

Article: http://theoncologist.alphamedpress.o...t/5/4/302.full

S-setting up
E-emotions and empathy

The article has more information. I don't mean do it 100% like that but those steps should be good for any "bad news" kind of situation. Obviously the order may be altered slightly and the phrases don't' have to be exactly like I wrote them here. I just made up some examples.

E.g -
S: Sir, there is something I would like to talk to you about. I'm afraid they aren't very good news. Before we start, I am turning off my phone/locking the door/making sure we won't be bothered [whatever you can say or do]. Also, are you comfortable? Would you like to bring in someone else so that we can all discuss this together? (family, etc.)

P: What do you know about your current condition? Do you know why we did these tests? [...]

I: [wait for the patient to somehow give you a "green light". Some patients do not want to be told bad news and would prefer that you told someone else or told no one]

K: I'm sorry to tell you that ... [insert results of biopsy/tests/etc.] Use simple vocabulary and be honest but not brutal. Make sure that you tell the bad news in such a way that it is clear that you are still there to help the patient in whatever ways you can

E: express empathy. Critical for CS! The article I linked has very good example empathetic responses (table 2)

S: strategy - what is next? What are your plans? Also, negotiate these plans with the patient. They may not want chemo/radiation/palliative care/whatever so this should fit with the patient's desires

I thought this would be good for this forum since everyone here likes mnemonics so much!
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The above post was thanked by:
basha (04-03-2015), ddaydreamer (08-26-2013), dr.Zh (12-05-2012), drhnis (01-13-2013), fati9445 (08-05-2012), meanmr.mustard (08-02-2012), mehdirah (12-08-2015), MerryM (10-25-2016), nepb (11-11-2012), punamrjpt (03-03-2013), Ramon Santos (07-09-2013), sdchitnis (05-24-2013), shima (04-08-2012), tinhi (07-08-2012), USMLEBoy (02-23-2013), zarina (05-19-2012)



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