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OSCE Session InformationGiving Kithma WijesooriyaPossibleInformationgivingstations 1. MedicationCounselling i. Metformin ii. Insulin iv. Warfarinexate v. Contraception 2. DiagnosisCounselling i. Diabetes ii. COPD iii. Hypertension iv. Epilepsy 3. Procedure Counselling i. Endoscopy/colonoscopy 4. Other i. Smoking cessation ii. Inhaler technique1. Introduce yourself 2. Confirm name and date of birth 3. Explain purpose of the consultation + patients expectations from the consultation 4. Prior knowledge 5. Chunk and check 6. Encourage patient to ask questions 7. Summarise 8. Give written material to take home 9. Contact information 10.Thank the patientMedicationCounselling Case 1 Mr.X is a 60 year old male patient who is being started on Warfarin for Atrial Fibrillation.Sohowdoyou wantto starttheconsultation…Sohowdoyou wantto starttheconsultation 1. Introduce yourself 2. Confirm name and date of birth 3. Explain purpose of the consultation Today we are going to talk about warfarin…. 1. Prior knowledge i. Whatdoyou alreadyknowaboutwarfarin?Explainwhatwarfarinis - Anticoagulant - Thinstheblood - Reducelikelihoodofclots formingHowto takeit - Every day at the same time - Tokeep levelssteady - Usuallyat6pm - Usuallylifelongor untilyou doctor tellsyou to stopMisseddoses - Take the missed dose as soon as you remember - Never take two doses at once - Inform the doctor/nurse about missed doses at your next appointmentSideeffects - Minor Bleeding - usually settles on its own and can carry on taking warfarin - Epistaxis - Bleedinggums - Bruising - Major bleeding - Seek medical advice - Haematuria - Haematemesis - MalenaMonitoringandfollowup INR - Blood test - Dose of warfarin based on INR level - Target INR range What to take to follow up appointment - Yellow bookletLifestyleadvice - Food high in Vit K can affect warfarin levels - Alcohol intake - Cranberry juiceOther importantinformation - Let your doctor/anticoagulation nurse know if you have been prescribed new medications since the last visit (including herbal medication) - Let other health professionals know you are on warfarin ie dentist, pharmacist, podiatrist etcAttheend Summarise Give Leaflets Safety net Thank the patient DiagnosisCounselling i. Diabetes ii. COPD iii. Hypertension iv. Epilepsy v. MultipleSclerosisCase 2 - Mrs A has come to the GP to discuss her recent blood pressure measurements. Explain the diagnosis and management plan with the patient1. Introduce yourself 2. Confirm name and date of birth 3. Explain purpose of the consultation + patients expectations from the consultation 4. Prior knowledge 5. Chunk and check 6. Encourage patient to ask questions 7. Summarise 8. Give written material to take home 9. Contact information 10.Thank the patientHypertension What is it? - Normal anatomy and physiology - Heartis a muscularstructureinour chestthatpumpsblood tothe restof our body - In Hypertension - Pressureof theblood goingaroundthebody is too high - Strainon the heart→ heartproblems(MI) - Causea blood vesseltoburstin eye/brain/kidneysWhatdo thetop andthebottomnumbersmean ?High blood pressure: STAGE1 - Between 140/90 mmHgand 160/100 mmHgin the clinic,or 135/85 mmHg to 150/95 mmHg at home. STAGE2 - Between 160/100 mmHgand 180/120 mmHgin the clinic,or over 150/95 mmHgat home. STAGE3 - Systolic over 180 mmHgor diastolic bloodpressureis over 120 mmHg in theclinic.Management Lifestyle modifications 1. Regular exercise 2. Eat a healthy diet 3. Quit smoking 4. Limit alcohol 5. Manage stressMedication If <55 or Type 2 diabetes → ACEI or ARB If >55 and No Type 2 Diabetes OR African/caribbean ethnicity → CCBAttheend Summarise Patient questions Give Leaflets/links Safety net Thank the patientAdviceforOSCEs in General 1. Be polite 2. Read the question! Only do what is asked of you 3. Always ask about red flag symptoms 4. Always safety net 5. If you don't know something it is okay to tell the patient/examiner you don't know but say you will ask a senior/look in BNF/Look in hospital guidelines etc 6. Practice, Practice,PracticeFeedbackQR code