Mock 10

Clinical Scenario for Role Play: Confidential HIV Diagnosis

Background Information:

• You are an F2 doctor in a GP practice.
• John Bernard, aged 40, previously presented with generalized lymphadenopathy.
• Blood tests including FBC, LFTs, U&Es, and a urine chlamydia screen were normal.
• HIV testing was positive (both antibody and p24 antigen).

Patient Profile:

• Male, 40 years old.
• Presented initially for generalized lymphadenopathy.
• Diagnosed with HIV, which he has not disclosed to his wife and wishes to keep confidential.

Scenario Setup:

• John returns to the clinic to discuss his test results.
• Your task is to discuss his HIV diagnosis, address the confidentiality concerns, and manage his condition moving forward.

Patient Prompts:

1. Receiving the Diagnosis:
   • John might express shock or concern: "Are you sure the tests are correct? What does this mean for me?"
2. Concern About Confidentiality:
   • He might say, "I don't want my wife to know about this. Can you assure me this will remain confidential?"

Clinchers:

• Discussing the Diagnosis:
  • "John, I understand this news can be very overwhelming. The tests we performed are highly accurate, and it’s important that we discuss how to manage your health moving forward."

Important Points to Keep in Mind:

• Medical Management:

  • Outline the importance of further assessments, such as CD4 count and viral load tests, to determine the stage of HIV and tailor the management plan.
  • Discuss antiretroviral therapy (ART) as a cornerstone of HIV treatment to control the virus and prevent its progression.

• Confidentiality and Disclosure:

  • Reassure him about confidentiality in medical settings, explaining that his diagnosis will not be disclosed without his consent, except in situations where there is a legal obligation to inform others (discuss the legal and ethical boundaries as per local regulations).
  • Stress the importance of disclosing his status to his wife, especially for her health, and discuss strategies and support services that can assist with this sensitive issue.

• Psychological Support:

  • Acknowledge the emotional impact of the diagnosis and recommend counseling services that specialize in chronic illness management and coping strategies.
  • Provide information about local support groups and resources for individuals living with HIV.

Expected from the Doctor:

• Professionalism and Empathy:

  • Approach the consultation with empathy, understanding, and professionalism, maintaining a non-judgmental tone throughout the discussion.

• Clear Communication:

  • Communicate clearly and thoroughly, ensuring John understands his condition, the implications, and the next steps.

• Coordination of Care:

  • Plan for regular follow-ups and coordinate care with specialists in infectious diseases or clinicians experienced in managing HIV.

• Documentation and Follow-Up:

  • Document the consultation carefully while respecting confidentiality. Arrange for follow-up appointments to monitor his response to treatment and address any subsequent concerns or questions.

This scenario challenges the candidate to manage a sensitive and complex medical condition with significant ethical, social, and medical dimensions. It tests the ability to deliver difficult news, manage patient autonomy and confidentiality, and coordinate comprehensive care.