Concerns About Missed Diagnosis of Lung Cancer OSCE Walkthrough in PLAB 2 and UKMLA CPSA

Scenario Overview

You are an FY2 doctor working in the respiratory unit. Mrs. Emily Jacobs, a 72-year-old woman with COPD and a history of smoking, was admitted two days ago with a cough and has now been diagnosed with lung cancer. Her son is upset and believes the GP missed the diagnosis. He wants to speak with you to discuss his concerns. Your task is to address his worries empathetically, gather relevant information, and explain the next steps while maintaining professionalism and neutrality.

Key Objectives

1. Listen to and validate the son’s concerns empathetically.

2. Gather details about the patient’s symptoms, GP visits, and treatment history.

3. Explain the investigative process for such cases.

4. Maintain neutrality—do not blame or defend the GP.

5. Provide appropriate referrals and reassure the son about next steps.

Steps to Approach the Station

Step 1: Introduction and Agenda Setting

• Begin by introducing yourself and setting the tone for the conversation:

  • “Hello, I’m Dr. [Your Name], one of the doctors looking after your mother. I understand you had some concerns about her care, and I’m here to discuss them with you. Could you tell me what’s been worrying you?”

Step 2: Acknowledge and Validate Concerns

• Show empathy and understanding:

  • “I’m really sorry to hear about your mother’s recent diagnosis. I understand this must be a very difficult and worrying time for you and your family.”

  • “I can see why you’re concerned about whether anything might have been missed. It’s natural to have these questions, and I’ll do my best to address them.”

Step 3: Gather Information

• Use open-ended and focused questions to gather details:

  • “What made you think the GP might have missed something?”

  • “Can you tell me more about her symptoms before she was admitted?”

  • “How long had she been seeing the GP for these symptoms?”

  • “Do you know if any tests were done, such as X-rays or blood tests?”

• Clarify specifics about symptoms and treatment:

  • “Was she experiencing any persistent cough, weight loss, or difficulty breathing?”

  • “Was she given any treatments, like antibiotics? Did they help?”

  • “Has she ever had similar symptoms before?”

Step 4: Address Concerns Without Assigning Blame

• Emphasize that you don’t have all the information:

  • “At this point, we don’t have the full details about your mother’s GP visits or the tests and treatments she received. Without this information, it’s difficult to say if anything was missed.”

  • “What we can do is ensure that your concerns are escalated appropriately so they can be thoroughly reviewed.”

Step 5: Explain the Investigation Process

• Outline the steps that will be taken:

  • “Because you’ve raised this concern, we will escalate it to our senior team. They will review your mother’s medical records, including her GP notes and any previous investigations.”

  • “If they find any significant concerns, they may recommend further investigation by the hospital administration or refer the case to the General Medical Council (GMC), which oversees doctors in the UK.”

Step 6: Offer Referrals to Support Services

• Provide information about PALS:

  • “You can also contact the Patient Advice and Liaison Service (PALS) here at the hospital. They act as advocates for patients and their families and can help you raise a formal complaint if that’s something you wish to do.”

  • “They can guide you on how to get more detailed answers to your questions.”

Step 7: Reassure and Support

• Reassure the son about the care moving forward:

  • “Your mother is now in our care, and we are doing everything we can to support her. I want to assure you that your concerns are being taken seriously, and we will keep you informed every step of the way.”

• Validate his emotions:

  • “It’s completely understandable to feel upset and frustrated in this situation. Please don’t hesitate to let us know if there’s anything else we can do to support you.”

Step 8: Safety Netting and Follow-Up

• Explain what to expect next:

  • “The senior team will review your mother’s case, and we will let you know if there are any findings or next steps. In the meantime, if you have additional questions, please feel free to reach out.”

• Provide contact information for PALS and ensure open communication.

Key Points to Remember

1. Empathy: Validate the son’s concerns and acknowledge his emotions.

2. Neutrality: Avoid defending or blaming the GP; focus on the investigation process.

3. Transparency: Clearly explain the steps involved in addressing his concerns.

4. Support: Offer resources like PALS to provide additional assistance.

5. Reassurance: Emphasize that his mother’s care is a priority and his concerns are being taken seriously.

This structured approach ensures the son feels heard and supported while maintaining professionalism and adhering to the scope of your role.