The following points are useful to bear in mind for this station:
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Greet the patient with hand shake and be courteous to the patient
and always appear sympathetic.
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If you were given result to go through such as a histology report or biometry
always make sure you verify the patient in front of you is indeed
the person you are going to break the news to (this will give you extra
points by showing to the examiner you are careful and thorough).
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Instead of giving a long-winded explanation of a condition such as retinoblastoma
find
out how much the patient know about the condition and his or her understanding
of the treatment options. This can help you to plan your communication.
For example a patient has a mass in the choroid and has had a chest X-ray
which reveal multiple lung metastasis, you may start by saying 'We carry
out some investigations after we discover that you have a lesion in your
eye. Do you know what we are looking for?'. Another example a couple
came to you because their first child has bilateral retinoblastoma and
now they are considering a second child, you may ask 'Your first child
has retinoblastoma in both eyes. How much have you been told about this
condition and what do you know about the risk of your second child having
the problem?' Their answers will make it easier for you to tailor the
information needed.
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Encourage the patient to ask question by pausing in between dialogue.
For example if you have to tell a patient that he or she has cancer, you
can say ' I am afraid I have bad news to tell you.' and pause, the
patient (usually an actor or actress) will ask ' Is it cancer?' This is
better than bluntly tell the patient that he or she has cancer.
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Do not overwhelm the patients with information. Give two or three
pieces of information at a time and pause to let the patient digest the
information. Encourage the patients to ask questions. For example when
describing the various options in treating a painful blind eye you may
ask ' Do you understand the information I give you or is there some
questions that you would like to ask?'
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Find out if there is anybody in the patient's family who need to participate
in the counselling or further management of the problem. For example,
in discussing the likelihood of retinoblastoma in a second baby ask ' Is
your husband or wife aware of your desire of having second baby? Would
be possible for your husband or wife to be present during the discussion?'
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Find out the patient's wishes and fears when proposing a procedure.
For
example, when proposing a cataract operation find out if the patient prefer
to read without glasses or with glasses, you may say something like'
We will put an artificial lens to replace your lens during the cataract
operation. Following the operation, your vision will be altered. As you
are short-sighted at the moment, you can read without your glasses though
no too clearly. Following the operation, we can change your vision such
that you may not need glasses for the distance. However, the trade off
is that you will need glasses for reading. Would you prefer to read with
glasses or without glasses?' or when suggesting a local anaesthesia
for cataract operation ask ' Most of the cataract operations in our
department are carried out under local anaesthesia. You will be awake during
the operation but should not feel any pain. Do you have any objection to
having the operation with you awake?'
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Using the word 'but' when giving bad news can lessen the despair.
For example in a patient with poor eyesight due to advanced macular degeneration,
you may say ' The condition is not treatable at this stage but you are
not going to lose your sight completely. Your peripheral field will allow
you to have full mobility unaided. We can arrange low visual aid appointment
to assess if your reading may benefit from magnifying devices.'
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You may draw a diagram or model to explain a procedure (for example
trabeculectomy or cataract operation) or a pathology (cataract, age-related
macular degeneration etc).
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