Scenarios with Depression causing weightloss: Examiner top tips

Mock examiner feedback for a free mock performed on 10/06/2024

Time Management

• Equal Division of Time:

  • Allocate 4 minutes for data gathering and 4 minutes for management.

  • IPS (Interpersonal Skills) is assessed throughout the entire consultation.

• Two-Minute Bell:

  • Use the two-minute bell as a signal to start the management phase.

  • Do not wait until the bell; aim to finish data gathering within 4 minutes.

Data Gathering

• Patient Identification:

  • Always ask for the patient's full name and age.

• Presenting Complaint:

  • Start with an open question to elaborate on the patient's complaint.

  • Use open-ended questions to encourage the patient to reveal the main issue.

• Formulating Differentials:

  • Immediately think of differential diagnoses upon hearing the presenting complaint.

  • Prioritize the most critical potential issues first.

• Structured Questions:

  • Ask focused questions to rule out serious conditions (e.g., cancer, depression).

  • Use symptom-specific questions to narrow down the diagnosis.

Key Areas to Cover in Data Gathering

• Medical History:

  • Past medical history, medications, and family history.

• Social History:

  • Assess the patient's support structure, family, job, and activities.

• ICE (Ideas, Concerns, and Expectations):

  • Ask about the patient’s ideas, concerns, and what they hope to achieve from the consultation.

• Examination:

  • Perform necessary examinations as part of data gathering.

Management Phase

• Diagnosis Explanation:

  • Offer an explanation of the diagnosis briefly and check the patient's understanding.

• Treatment Options:

  • Discuss all treatment options including medications and therapy sessions.

• Crisis Plan:

  • Develop a plan for the patient to follow if they experience severe symptoms or suicidal tendencies.

  • Provide emergency contact numbers or support resources.

• Addressing Concerns:

  • Incorporate the patient's concerns and support needs into the management plan.

• Final Steps (Two-Minute Bell):

  • Ensure to include safety netting, follow-up, and provide leaflets or pamphlets.

Interpersonal Skills (IPS)

• Empathy and Signposting:

  • Show empathy throughout the consultation.

  • Signpost changes in the line of questioning to prepare the patient.

• Listening and Response:

  • Actively listen and respond appropriately to the patient's statements.

Improvement Points

• Internal Time Awareness:

  • Develop an internal clock to manage time effectively without relying on external cues.

• Consultation Flow:

  • Maintain a logical flow in the consultation without abrupt changes in topics.

• Avoid Unnecessary Permissions:

  • Do not ask for permission to ask questions; proceed with necessary inquiries confidently.

• Focus on Main Issues:

  • Identify and address the patient's main issues rather than peripheral symptoms.