Lesson 8.10 — Mock 10: Urgent Referral That the Patient Refuses
Candidate Page
You believe a patient needs urgent hospital assessment. Discuss this with them and make a safe plan.
Consult naturally. Do not try to force every communication skill into the case. Identify the patient’s agenda and use it to shape the consultation.
Role-Player Brief
You are the only carer for your disabled spouse and say you cannot go to hospital today. You understand the doctor is concerned but feel you have no practical option.
If the candidate explores well
- If the candidate explores the barrier, discuss who might possibly help for a few hours.
- If the seriousness is explained clearly, acknowledge the risk.
If the candidate misses the cue
- If they repeat “you must go” without problem-solving, become distressed.
- If they minimise the risk to accommodate you, ask “So it isn’t really urgent then?”
- Explore the barrier.
- Explain concern clearly.
- Problem-solve without coercion.
- Respect autonomy while maintaining clinical responsibility.
Shared decision-making does not mean pretending all choices are equally safe. State your recommendation, then work with the barrier.
| Reflection | Yes / Partly / No | Evidence from the consultation |
|---|---|---|
| I found the real agenda. | ||
| I responded to the key cue. | ||
| My explanation used patient-specific information. | ||
| The plan was shared and clinically owned. | ||
| My safety-net was specific. | ||
| I sounded natural rather than scripted. |