You are an FY2 in GP surgery (telephone consultation)
Personal Details:
Name: Daniel Smith
Age: 25
Medical Record:
Past medical history: None.
Notes:
A 25-year-old man is calling for his blood test results. He attended the ‘well man’ clinic last week with a penile ulcer. He is sexually adventurous, does not have a regular partner, and uses cocaine occasionally. The blood test result is positive for syphilis (TPHA positive).
Task:
1. Disclose the new results and address his immediate reaction and concerns.
3. Explain the treatment plan.
Opening Sentence: “Hi, Doctor, you’ve got my results? I’ve been really worried.”
Open History (to give freely): “That sore on my penis has gone now, but I’m still worried about what it was. I’ve been with a few people recently.”
ICE (Ideas, Concerns, Expectations):
Ideas: “I thought it might be herpes or something.”
Concerns: “Is it serious? Can it be cured?”
Expectation: “I’m expecting you to tell me what’s wrong and what the treatment is.”
How to Act: You are anxious. When you hear the diagnosis of syphilis, you become very upset and distressed. You feel ashamed.
More History (only if asked): You have multiple sexual partners, both male and female. You don’t always use condoms. You have never had an STI before.
Social History: Lives alone. Uses cocaine recreationally.
Questions to ask:
“Syphilis? I thought that was an old disease. How did I get it?”
“What’s the treatment? Do I have to tell everyone I’ve slept with?”
Opening & Confirmation:
Hi, is that Daniel Smith? I’m Dr. [Name] from the clinic. I’m calling with your test results. Is now a good time to talk? Are you somewhere you can talk freely?
Breaking the News (Warning Shot): I have the results here. I’m afraid it’s not straightforward news. The test has come back positive for an infection called syphilis. I know that can be a real shock to hear. (Pause, allow for reaction)
Sexual History & Risk Assessment: To make sure we give you the right treatment, I need to ask a few more questions about your sexual partners. In the last few months, how many people have you had sex with? Are your partners male, female, or both? Do you always use condoms?
ICE (Ideas, Concerns, Expectations): What are your first thoughts on hearing this news? You asked if it’s serious and if it can be cured. What do you already know about syphilis? What’s your biggest worry right now?
Social history: I would like to know more about your day to day life style habits, as it could be relevant to our conversation. Do you smoke? Do you drink alcohol? Do you use any recreational drugs?
Addressing and answering the patient’s ICE:
You’re asking how you got it and if it’s serious. Syphilis is passed on through sexual contact. You’re right that it’s an old disease, but we have seen a big resurgence in recent years. The good news is that it is completely curable with a straightforward course of antibiotics. The key is treating it properly.
Next Steps:
The treatment is a course of penicillin injections. You will need to attend the GUM (Genito-urinary Medicine) clinic for these. It’s usually a single injection, but depending on the stage, it might be a course of three injections, one each week for three weeks.
They will also offer you a full screen for other STIs, including HIV, as having one STI increases your risk of having others.
Partner notifications:
You asked if you have to tell your previous partners. Yes, this is a really important part of the management. We need to contact anyone you have had sex with in the last three months so they can get tested and treated. This is called partner notification. It can be done anonymously; you don’t have to do it yourself. We have specialist health advisors at the GUM clinic who are experts at this. They can send a text or a letter without ever using your name.
I know this is a lot to take in over the phone. Do you have any questions at this stage?
I will contact the sexual health clinic (GUM) to let them know, and they should contact you very soon, within a day or two, to offer you a face-to-face review, start the treatment and offer a full STI screen. We will support you through this.
Addressing ideas, concerns, and expectations: Reassure him that syphilis is curable. Explain the treatment (penicillin injections). Explain the process and importance of partner notification, emphasising the anonymous options.
The management is to arrange an urgent face-to-face appointment at the GUM clinic for treatment and further screening. The key is to provide a supportive and non-judgmental plan of action.
What is scenario testing? This case tests the candidate’s ability to break bad news of a significant STI over the phone. It requires clear knowledge of the treatment for syphilis and the principles of partner notification. The communication challenge is to be supportive and non-judgmental while conveying the public health importance of treatment and contact tracing.