Mock 11

Patient Prompts

• Mr. Miller expresses intense worry about having prostate cancer: "I’ve read about the symptoms online, and I’m terrified I might have it."
• He requests specific tests for prostate cancer, indicating a high level of anxiety about his health.

Scenario Clinchers

• Despite having no urinary symptoms or significant risk factors, his anxiety has led him to fixate on the possibility of having prostate cancer.
• He is seeking reassurance through diagnostic testing but also exhibits a clear pattern of health-related anxiety.

Patient Concerns

• His anxiety seems to be focused on the fear of a serious illness, which is currently manifesting as a concern about prostate cancer.
• He might have misconceptions about prostate cancer symptoms and the benefits/risks of screening.

Clinchers and Important Points for the Doctors

• Understanding the patient's anxiety background is crucial to address his concerns effectively and to differentiate between anxiety symptoms and actual medical symptoms.
• The decision to screen for prostate cancer should be based on clinical guidelines, patient age, risk factors, and a balanced discussion about the benefits and risks of prostate cancer screening.

What Is Expected from the Doctor

• Conduct a thorough history and physical examination, including a digital rectal examination if indicated, to assess the prostate and discuss the findings with the patient.
• Engage in a detailed discussion about the risks and benefits of PSA testing, considering his age, risk factors, and anxiety level.
• Address his anxiety by providing reassurance, exploring the source of his fears, and ensuring ongoing support, possibly adjusting his anxiety management plan.

Red Flags

• New onset urinary symptoms, such as difficulty urinating, nocturia, hematuria, or pain, which could warrant further urological evaluation.
• Signs of severe anxiety or panic disorder that might require pharmacological intervention or referral to mental health services.

Actions Doctor Should Do

• Consider the appropriateness of PSA testing and/or referral to urology based on a balanced discussion with the patient, clinical findings, and guidelines.
• Reinforce the importance of continuing his counseling sessions and consider whether his current anxiety management strategy needs to be revisited or adjusted.
• Offer resources or referrals for further psychological support, if needed, and ensure there is a follow-up plan to discuss the test results and next steps.

Referral Needs

• Referral to a urologist may be considered if the PSA test is abnormal, if there are significant clinical findings on examination, or if the patient has persistent concerns despite reassurance.
• Further mental health support, possibly adjusting his existing therapy or exploring medication, if his anxiety is significantly impacting his quality of life.

Reason for Referral

• Urological evaluation is to ensure that there is a comprehensive assessment of his prostate health, especially if screening tests are suggestive of further investigation.
• Enhanced psychological support is to address the underlying anxiety, particularly if it is exacerbating health anxieties or if there are signs of progression in his anxiety symptoms.