This book takes readers through forty-five challenging scenarios to teach communication skills in medicine. It follows the revised format of the Practical Assessment of Clinical Examination Skills (PACES) exam conducted by the Royal College of Physicians in the UK, which tests communication skills twice in two separate stations. As most scenarios in this book have been created in an acute medical unit setting, the approach followed should also appeal to senior medical students and trainees in internal medicine and general practice at all levels. Readers will learn:

• How to convey abnormal test results and break bad news.

• How to discuss the diagnosis of a chronic disease and negotiate a management plan.

• How to communicate with patients who pose an ethical dilemma.

• How to communicate with challenging patients and relatives.

• What to tell patients or relatives when things go wrong.

• How to communicate with patients and relatives regarding end-of-life issues.

Key Features:

• Takes readers through a simple step-by-step approach to skillfully dealing with common challenging communication scenarios they face in their daily practice.

• Guides readers on how to communicate in layman’s terms without using medical jargon, as it is fully dialogued, proving particularly helpful to non-UK candidates, whose first language is not English.

• Simplifies several complex ethical and medicolegal principles, such as treatment of patients lacking capacity, dealing with patients who refuse consent, confidentiality, counselling a non-compliant patient, basic genetic counselling, management of patients who demand non-indicated investigations or treatments, open disclosure after a medical error, preparing an advance decision and lasting power of attorney, issues around brain death and organ donation, tube feeding, Do Not Attempt Resus- citation orders and referral to the coroner.

SECTION I

Conveying Abnormal Test Results

Case 1 The 51-Year-Old Woman with a Possible Brain Tumour

Case 2 The 22-Year-Old Woman with Type 1 Diabetes

Case 3 The 28-Year-Old Woman with a Positive HIV Test Result

Case 4 The 66-Year-Old Man with Advanced Pancreatic Cancer

Case 5 The 74-Year-Old Man with Acute Myeloid Leukaemia

Case 6 The 27-Year-Old Woman with Possible Coeliac Disease

Case 7 The 30-Year-Old Woman with Tuberculosis

Case 8 The 34-Year-Old Man with Hypertrophic Cardiomyopathy

SECTION II

Counselling on Disease Management

Case 9 The 22-Year-Old Man with Recurrent Episodes of Fainting

Case 10 The 24-Year-Old Pregnant Woman with Suspected Pulmonary Embolism

Case 11 The 37-Year-Old Woman with Functional Dyspepsia

Case 12 The 46-Year-Old Man with Poorly Controlled Diabetes Mellitus

Case 13 The 78-Year-Old Woman with Hyponatraemia

Case 14 The 26-Year-Old Woman Who Has Had an Anaphylactic Reaction

Case 15 The 48-Year-Old Man with Alcohol Use Disorder

Case 16 The 28-Year-Old Woman with Possible Lupus Nephritis

SECTION III

Capacity, Consent, and Confidentiality

Case 17 The 19-Year-Old Girl Whose Father Objects to a Lumbar Puncture

Case 18 The 66-Year-Old Man Who Does Not Wish to Start Dialysis

Case 19 The 33-Year-Old Man Who Is Refusing the HIV Test

Case 20 The 52-Year-Old Man Who Wants to Get Discharged against Medical Advice

Case 21 The 77-Year-Old Man Whose Daughter Asks You Not to Reveal the Diagnosis of Cancer to Him

Case 22 The 37-Year-Old Man with Gonorrhoea Who Asks You Not to Tell His Wife about His Diagnosis

SECTION IV

Challenging Patients and Relatives

Case 23 The 26-Year-Old Man Who Is Asking to Be Tested for Huntington’s Disease

Case 24 The 46-Year-Old Man Who Is Not Compliant with His Anti-Hypertensive Medication

Case 25 The 65-Year-Old Woman Who Wants to Try Herbal Treatment for Her Lymphoma

Case 26 The 24-Year-Old Man with Difficult Asthma

Case 27 The 63-Year-Old Woman Whose Husband Asks You Not to Discharge Her

Case 28 The 42-Year-Old Man with Non-Specific Back Pain Who Demands a Scan

Case 29 The 47-Year-Old Man Who Is Demanding Strong Opioids for His Chronic Back Pain

Case 30 The 43-Year-Old Woman with No Diagnosis Despite Extensive Evaluation

Case 31 The 66-Year-Old Man Whose Sister Does Not Agree with Your Diagnosis

SECTION V

When Things Go Wrong

Case 32 The 68-Year-Old Man Whose Stroke Was Not Diagnosed in Time

Case 33 The 74-Year-Old Woman Who Has Suffered Harm Because of a Medication Error

Case 34 The 78-Year-Old Man Who Fell Off His Bed in the Ward

Case 35 The 73-Year-Old Man Who Was Exposed to COVID in the Hospital

Case 36 The 27-Year-Old Woman with a Severe Allergic Reaction to Sulfasalazine

Case 37 The 69-Year-Old Woman Whose Cord Compression Was Not Diagnosed in Time

SECTION VI

End-of-Life Issues

Case 38 The 69-Year-Old Woman Who Wants to Make a Living Will

Case 39 The 82-Year-Old Woman for Whom the Medical Team Feels That CPR Should Not Be Attempted

Case 40 The 68-Year-Old Man with Motor Neurone Disease Who Needs Artificial Feeding

Case 41 The 70-Year-Old Man with Acute Exacerbation of COPD

Case 42 The 81-Year-Old Man Who Is Terminally Ill

Case 43 The 45-Year-Old Man with Severe Brain Haemorrhage

Case 44 The 59-Year-Old Man Who Has Just Died from Myocardial Infarction

Case 45 The 53-Year-Old Woman Whose Death Is Unexplained

About the Author

Dr. Ernest Suresh is currently the head of medicine at Ng Teng Fong General Hospital in Singapore. Over the last three decades, he has worked in three different countries with contrasting healthcare systems and cultures. He has been teaching MRCP candidates for over two decades and received more than a dozen teaching excellence awards in the last ten years alone. He has regularly published educational review articles on a wide range of topics in peer-reviewed internal medicine journals and written an acute medicine handbook to guide the junior doctors in his hospital. His previous book, Clinical Consultation Skills in Medicine: A Primer for MRCP PACES, takes readers through a simple, clear and rational approach to 63 common presenting symptoms or laboratory abnormalities in medicine.

He believes that all doctors, regardless of their speciality, should practice holistically, and learn to treat the person that has the illness and not just the illness the person has. He considers himself an ‘old-fashioned clinician’ and pays a lot of attention to bedside clinical skills and communication, the essential traits that the Royal College expects PACES candidates to possess.