You are an FY2 in the medical ward

Personal Details:

Name: Mrs Davis (patient), Mr Davis (son)

Age: 78

Medical Record:

Past medical history: None significant.

Notes:

Mrs Davis, a 78-year-old woman, was admitted yesterday with shortness of breath. An X-ray has revealed features highly suspicious of lung cancer. Her son, who is her power of attorney (POA) and primary carer, is extremely angry. He states that his mother saw her GP three weeks ago with a cough and was diagnosed with a common cold. He believes the GP was negligent and wants to make a formal complaint. He has been updated about the X-ray result by one of your colleagues over the phone.

She is now booked for a CT chest and abdomen, and has been referred to the lung team, who should see her today after the CT scan.

Task:

Talk to the son and acknowledge his anger and distress, and discuss a management plan.

Opening Sentence: “Doctor, am not very happy regarding my mum's care. I knew from your colleague that the chest X-ray was showing features of cancer. She saw a GP around 3 weeks ago, and he sent her away with a pat on the head three weeks ago! It’s a disgrace.”

Open History (to give freely): “She had a bad cough and a fever. He said it was just a cold. If he’d done an X-ray, then we could have caught this earlier. She could have started treatment weeks ago. He’s been negligent.”

Cues to give: “I’m going to sue him. I want to make a formal complaint right now.”

ICE (Ideas, Concerns, Expectations):

Ideas: “I think the GP is at fault and has made my mum’s condition worse.”

Concerns: “Why didn’t the GP do an X-ray earlier? Has this delay affected her chances?”

Expectation: “I expect you to agree with me and help me make a complaint against the GP.”

How to Act: You are angry, upset, and looking for someone to blame. You are very protective of your mother.

More History (only if asked): Your mother is your whole world. You care for her at home. You feel guilty that you didn’t push the GP harder at the time. You are channelling this guilt into anger.

Social History: You live with your mother and are her sole carer.

Questions to ask:

“Don’t you agree that the GP made a mistake?”

“What’s the point in treatment now if it’s already spread?”

Opening & De-escalation:

Mr Davis, I can see you are incredibly upset and angry, and you have every right to be. This is a huge shock. Please, sit down. Let’s talk this through.

Active Listening & Exploring the Story: Tell me what happened. You mentioned you saw the GP three weeks ago? What were your mother’s symptoms at that time? What did the GP say and do during that consultation?

ICE (Ideas, Concerns, Expectations): You feel that a mistake was made. What do you think should have happened differently? Your biggest concern is that this delay has harmed your mother.

Is that right? You want to make a complaint.

Refocusing on the Patient: Before we talk more about the complaint process, can we first talk about your mother? How is she doing right now? What does she understand about what is happening?

Explain the situation, the likely diagnosis or DD:

Mr Davis, thank you for speaking with me. I can see how angry and upset you are, and it is completely understandable. It is a huge shock to find out that your mother may have lung cancer, and it’s natural to look back and question what has happened. Your mother has given consent for me to speak with you, and I want to be as open as I can.

Addressing and answering the patient’s ICE:

You feel that the GP should have done an X-ray three weeks ago and that this delay has been harmful. It is very common for chest infections and colds to be the first presentation of something more serious. From the GP’s perspective, seeing an elderly patient with a cough and fever, the most common and likely diagnosis is a simple chest infection. It is not standard practice to X-ray every elderly person with a cough. However, I understand that with the benefit of hindsight, this is very frustrating and upsetting for you.

Next Steps:

In terms of whether the last three weeks would have made a significant difference to her overall outcome, it is unlikely. Lung cancer is a disease that typically develops over many months or even years. While every day feels precious, a delay of a few weeks is unlikely to have changed the stage of the disease or the treatment options available to her.

Right now, the most important thing we can do is focus all our energy on your mother and her care. Our priority is to get a clear diagnosis and make a treatment plan for her.

You have every right to make a complaint about the GP, and I can give you a leaflet explaining how to do that through the formal PALS (Patient Advice and Liaison Service) process, and you can directly send your complaint to the manager of the GP practice. However, I would suggest that for today, we focus our attention on your mum.

Next step

“Let’s talk about what happens now for her. We have referred her to the specialist lung cancer team, and we will arrange for her to have scans to obtain more information and confirm the diagnosis, as it could be difficult to make a definitive diagnosis of what is going on based on the chest x-ray. Once we have that information, we can discuss the best treatment options.

Have I answered your questions today?

Addressing ideas, concerns, and expectations: Do not be drawn into criticising the GP. Explain the rationale for the GP’s original diagnosis in a neutral way. Gently manage his expectation that a few weeks would have dramatically changed the outcome. Do not dismiss his anger.

Acknowledge his right to complain and provide the correct pathway (PALS), but skilfully defer this action to focus on the immediate clinical priority: his mother. Outline the next steps for his mother’s care (specialist referral, scans, biopsy).

What is scenario testing? This is a challenging communication station with an angry relative. It tests the candidate’s ability to de-escalate a conflict, show empathy, and refocus the conversation on the patient’s immediate needs. The key is to validate the relative’s feelings without validating their specific complaint of negligence against another professional.