Counselling of a Procedure

Scenario

Your role: You are the doctor in the general gastroenterology outpatient clinic Problem: Discussion regarding fear and misconception about Oesophago-Gastro-Duodenoscopy (OGDS) Patient: Mrs. Jennifer Armstrong, a 52-year-old woman You have been referred to this patient by her primary care physician. Mrs. Armstrong has been experiencing unexplained dyspepsia and reflux symptoms for the past 6 months, for which antacid and proton pump inhibitor therapy have proven ineffective. She has no alarming features such as weight loss, difficulty swallowing, or bleeding. However, given her age and persistent symptoms, an OGDS is recommended for further evaluation. Mrs. Armstrong, however, has voiced concern and apprehension about the procedure due to a lack of understanding and fear of invasive procedures. She has been avoiding scheduling the OGDS and is anxious about the process. Your task is to discuss the with the patient about the OGDS, explaining what it entails, how it is performed, the importance of the procedure in her case, and to alleviate her fears and misconceptions. Address her questions and concerns about the procedure. DO NOT EXAMINE THE PATIENT DO NOT TAKE A HISTORY. Any notes you make must be handed to the examiners at the end of the station.

Conducting the Station: A Step-by-Step Guide

Introduce Yourself: Begin the conversation by introducing yourself and your role to Mrs. Armstrong, ensuring she feels comfortable and secure. Acknowledge Her Concerns: Acknowledge her fears and concerns about the procedure, letting her know that it's completely normal to feel anxious about medical procedures. Discuss the Purpose of OGDS: Explain why an OGDS is important, especially given her persistent symptoms that haven't responded to medication. Inform her that it's a diagnostic tool that allows us to directly visualise the oesophagus, stomach, and upper part of the small intestine to determine the cause of her symptoms. Describe the Procedure: Clearly describe what she can expect during the procedure. Discuss the use of sedation to make the procedure more comfortable, the actual process of inserting the endoscope, and that it usually takes about 15-30 minutes. Discuss Potential Risks: Inform her of any potential risks associated with the procedure, but reassure her that these are rare and the procedure is generally safe. Also, mention that it's performed by experienced medical professionals. Emphasise Benefits and Importance: Emphasize the benefits of the procedure, mainly that it can provide crucial information to determine the most effective treatment plan for her symptoms. Reinforce the importance of the procedure in ensuring her health and well-being. Address Her Concerns: Ask Mrs. Armstrong if she has any specific concerns or questions about the procedure, and address these with clear, reassuring, and accurate information. Provide Written Information: If available, provide written information about the OGDS procedure for her to take home and review. This can be useful for her to digest the information at her own pace and may prompt further questions at a later time. Confirm Understanding: Before concluding, check if she has understood everything that's been discussed and if she has any other questions or concerns. Closing: End the session by summarising the main points discussed and reassure her that she can reach out at any time with more questions. Encourage her to consider the information discussed and make an informed decision about scheduling the OGDS.