FACEM Patient Communication Skills 2 — Questions and Answers
Question 1: A patient with limited English proficiency presents to the ED with chest pain. Which approach best ensures accurate history-taking?
- Use a family member who speaks the language
- Use a professional interpreter service (Correct answer)
- Rely on non-verbal cues and simple yes/no questions
- Ask nursing staff to translate
Correct answer: Use a professional interpreter service
Professional interpreter services ensure medical accuracy, confidentiality, and avoid role conflicts that arise when using family members.
Question 2: When breaking bad news in the emergency department, which framework is most appropriate?
- SBAR (Situation, Background, Assessment, Recommendation)
- SPIKES (Setting, Perception, Invitation, Knowledge, Emotions, Strategy) (Correct answer)
- SOAP (Subjective, Objective, Assessment, Plan)
- ISBAR (Introduction, Situation, Background, Assessment, Recommendation)
Correct answer: SPIKES (Setting, Perception, Invitation, Knowledge, Emotions, Strategy)
SPIKES is the evidence-based protocol specifically designed for breaking bad news in clinical settings.
Question 3: A distressed patient is shouting and refuses to let staff approach. What is the most appropriate initial communication strategy?
- Ask security to restrain the patient immediately
- Maintain a calm tone, use open body language, and allow the patient to express their concerns (Correct answer)
- Speak firmly and loudly to assert authority
- Leave the patient alone until they calm down
Correct answer: Maintain a calm tone, use open body language, and allow the patient to express their concerns
De-escalation begins with non-threatening body language, calm vocal tone, and actively listening to the patient's concerns.
Question 4: When obtaining informed consent for a procedure in the ED from a competent adult, what is the most important element?
- Getting a signature on the consent form
- Ensuring the patient understands risks, benefits, and alternatives in plain language (Correct answer)
- Having two nurses witness the consent
- Documenting the conversation in the medical record
Correct answer: Ensuring the patient understands risks, benefits, and alternatives in plain language
Valid informed consent requires that the patient understands the material information, not just signs a document.
Question 5: A tearful patient says 'I just want to know if I'm going to die.' How should the emergency physician respond?
- Reassure the patient that they will be fine
- Acknowledge the emotion and explore what they mean before providing information (Correct answer)
- Change the subject to focus on clinical findings
- Tell them only the doctor can answer that after all tests are done
Correct answer: Acknowledge the emotion and explore what they mean before providing information
Acknowledging emotion and clarifying the patient's concern before responding demonstrates empathy and gathers important context.
Question 6: Which communication technique is most effective when explaining a new diagnosis to an anxious patient in the ED?
- Use medical terminology to appear authoritative
- Provide all information at once to be efficient
- Use chunk-and-check: give small pieces of information and verify understanding (Correct answer)
- Provide a brochure and ask the patient to read it later
Correct answer: Use chunk-and-check: give small pieces of information and verify understanding
Chunk-and-check prevents information overload and confirms comprehension at each step, especially important for anxious patients.
Question 7: A patient declines a recommended blood transfusion citing religious beliefs. The patient is alert and competent. What is the correct response?
- Override the refusal as it is a life-threatening situation
- Respect the refusal, document it, and explore alternative treatment options (Correct answer)
- Contact the patient's family to convince them to accept treatment
- Apply to the court immediately for an order to transfuse
Correct answer: Respect the refusal, document it, and explore alternative treatment options
A competent adult has the right to refuse any treatment, including life-saving treatment, and this decision must be respected and documented.
FACEM Patient Communication Skills 2
A patient with limited English proficiency presents to the ED with chest pain.
Which approach best ensures accurate history-taking?