Lesson 6.4 — Case Lab: Scenarios 19–24
Case Lab 19 — Pregnancy loss follow-up
A patient attends after an early pregnancy loss.
“Everyone keeps saying it was early, like I shouldn’t be this upset.”
“I’m sorry for your loss. Are you still bleeding?”
The empathy phrase is followed immediately by clinical questioning, which may feel procedural.
“It sounds as though people have minimised what this loss meant to you. How have you been coping since it happened?”
Allow space, then assess physical recovery and emotional wellbeing, signpost support and safety-net appropriately.
How do you move back into clinical questions without sounding abrupt?
Case Lab 20 — Health anxiety and repeated tests
A patient repeatedly requests tests despite previous reassuring assessment.
“If you won’t do the scan, how can you know you haven’t missed something?”
“You’ve already had enough tests.”
The response may escalate mistrust and does not address intolerance of uncertainty.
“It sounds as though the uncertainty itself is very hard to live with. What are you hoping another scan would give you that the previous tests haven’t?”
Explain benefits and harms of further testing, agree a follow-up strategy and address anxiety without dismissing symptoms.
How would you set boundaries around repeated testing while preserving the relationship?
Case Lab 21 — Language barrier with family interpreter
A patient with limited English attends with an adult relative who offers to interpret.
The relative answers for the patient and edits some responses.
Proceeding entirely through the relative for convenience.
The patient’s autonomy, confidentiality and accuracy of communication may be compromised.
“Thank you for helping. For medical discussions, I’d like to arrange a professional interpreter so we can make sure your relative can speak privately and we understand everything accurately.”
Use appropriate interpreting services and continue to address the patient directly.
What if the patient strongly prefers the relative to interpret?
Case Lab 22 — End-of-life preferences
A patient with advanced illness asks about future care.
“I don’t want my daughter to think I’m giving up.”
“We should discuss a DNACPR.”
The candidate moves to a document rather than the meaning behind the patient’s fear.
“It sounds as though you want to plan ahead but you’re worried your daughter may hear that as giving up. What would you want her to understand about what matters to you?”
Explore priorities and values, then discuss appropriate advance-care planning sensitively and accurately.
How would you involve the daughter while keeping the patient central?
Case Lab 23 — Adolescent low mood
A teenager presents with low mood and a parent in the room.
Teenager: “There are things I can’t say with Mum here.”
“Mum, can you wait outside?” without explanation.
The direction may be appropriate but can create tension if handled abruptly.
“It can be helpful for me to spend a few minutes with young people on their own as part of the consultation. Would that be okay? I’ll also explain confidentiality and when I might need to share something for safety.”
Create private space, assess risk and safeguarding, and involve the parent appropriately with the young person’s consent and safety needs.
How would you respond if the parent refuses to leave?
Case Lab 24 — Patient wants 'natural' treatment only
A patient with a chronic condition is reluctant to use prescribed medication.
“I don’t like chemicals. I want something natural.”
“Natural doesn’t mean safe.”
Correct but confrontational; it may close down exploration of beliefs and goals.
“It sounds like avoiding medication is important to you. What does ‘natural’ mean to you, and what worries you about the treatment I’ve suggested?”
Discuss evidence, risks and alternatives respectfully. Identify where preferences can be accommodated and where safety limits need to be clear.
What if the patient is using an unproven supplement that may interact with medication?