Personal Details:

Name: Mr Liam Bell

Age: 22

Medical Record:

Past medical history: Investigated for haematuria (blood in urine).

Notes:

A 22-year-old man is attending the renal outpatient clinic for the results of his renal biopsy, which was performed a few weeks ago.

The expected clinical diagnosis is glomeronephritis.  

You have discovered that the biopsy sample was lost in transit to the laboratory, and no result is available. The consultant has asked you to speak to the patient.

Task:

1. Explain the medical error to the patient and handle the situation.

Opening Sentence: “Hi, Doctor, I’m here for my kidney biopsy results. I’m hoping you can finally tell me what’s going on.”

Open History (to give freely): “I’ve had this blood in my urine for weeks now. That biopsy was really painful, and I’ve been so worried waiting for the result. I just want to get it over with.”

Cues to give: “So what’s the result? Why is it taking so long?”

ICE (Ideas, Concerns, Expectations):

Ideas: “I assume you have the result and are going to tell me the plan.”

Concerns: “Why does it take so long? Is it bad news?” (After hearing the news) “You lost it? How can you just lose it? That’s unbelievable.”

Expectation: “I expect a diagnosis today.” (After hearing the news) “, I’m not going through that again. No way. You need to sort this out.”

How to Act: You start anxious but hopeful. When you hear about the error, you become extremely angry and distrustful. You feel let down by the hospital.

More History (only if asked): The first biopsy was a very unpleasant and painful experience. You are still passing some blood in your urine, although it’s a bit better than before. You feel completely let down.

Social History: University student.

Questions to ask:

How on earth do you lose a biopsy?

I’m not having another one. What else can you do?

What are you going to do about this mistake?

Opening & Setting the Scene:

Hi Liam, please come in and have a seat. Before we start, I need to let you know that I have some difficult news to discuss with you today.

Breaking the News & Apologising (Duty of Candour):

I am so sorry to have to tell you this, but there has been a serious error. The biopsy sample that was taken from your kidney was lost in transit to the laboratory, and we do not have a result.

I want to offer you a wholehearted apology. This is not acceptable, and we have let you down badly (Pause and allow for reaction)

Exploring His Reaction & Concerns:

I can see you are furious, and you have every right to be. What are your immediate thoughts?

You mentioned the first biopsy was very painful. Can you tell me about that experience?

You are saying you will not have another one. What is your biggest concern about repeating the procedure?

Assessing Current Clinical State:

Before we discuss what to do next, how have you been since the biopsy? Are you still noticing blood in your urine?

You are asking how this could happen. I have been trying to find out this morning. It seems there was an issue with the courier system, but whatever the reason, it is our responsibility. We have let you down badly. You went through a painful and worrying procedure for nothing, and we are launching a full investigation to make sure this never happens again.”

Next Steps:

You’ve said you are not willing to go through another biopsy, and I completely understand why you feel that way. The problem we face is that we still don’t know why you have blood in your urine.

The consultant planned for this as we were expecting that this could be because of inflammation in the kidney, which we call glomerulonephritis. The only way to confirm this diagnosis and, crucially, to know which specific type it is, is by looking at a piece of the kidney under a microscope.

I will have a chat with the consultant to update him that your symptoms are better, but there is still blood in your urine, and see what would be the best next action for you. Is that alright?

Acknowledge concerns

I know the first biopsy was very painful. We can make sure that for the repeat procedure, you are given much stronger pain relief and sedation to make you as comfortable as possible.

Further action

This is a serious incident, and we will be reporting it formally. You have the right to make a formal complaint through our PALS (Patient Advice and Liaison Service), and I can give you a leaflet on how to do that.

How are you feeling now?

Addressing ideas, concerns, and expectations: The primary objective is to apologise and take ownership of the error. Address his refusal by explaining the clinical risks of not having a diagnosis. Offer practical solutions to his concerns about a repeat procedure (better analgesia/sedation, consultant to perform it).

The management is communicative. 1. Apologise sincerely. 2. Explain the clinical need for a repeat biopsy. 3. Negotiate consent by offering improved conditions. 4. Explain the formal complaint process (PALS) and the hospital’s internal investigation (Duty of Candour).

What is the scenario testing: This is a very challenging communication station testing the candidate’s ability to handle a medical error under the principles of Duty of Candour. It requires a sincere apology, de-escalation of anger, and careful negotiation to persuade the patient to agree to a necessary procedure despite a breach of trust.