GAMSAT Patient Communication Skills 2 — Questions and Answers
Question 1: A patient with limited English proficiency arrives for a follow-up appointment without their usual interpreter. The most appropriate action is to:
- Proceed with the appointment using simple English and gestures
- Reschedule the appointment until a qualified interpreter is available
- Arrange a professional medical interpreter before proceeding with clinical discussion (Correct answer)
- Ask a bilingual family member in the waiting room to interpret
Correct answer: Arrange a professional medical interpreter before proceeding with clinical discussion
Professional medical interpreters ensure accurate clinical communication and protect patient confidentiality and safety.
Question 2: When delivering a serious diagnosis, the Calgary-Cambridge model recommends the physician first:
- Immediately present all treatment options to empower the patient
- Give a 'warning shot' to prepare the patient for difficult news (Correct answer)
- Ask the patient to bring a family member before continuing
- Document the diagnosis in the patient's chart before speaking
Correct answer: Give a 'warning shot' to prepare the patient for difficult news
A warning shot (e.g., 'I have some difficult news') prepares the patient emotionally and improves information retention.
Question 3: A patient repeatedly misses medication doses despite verbal counseling. The BEST next step to improve adherence is to:
- Switch to a simpler drug regimen without consulting the patient
- Explore the patient's specific barriers to adherence using open-ended questions (Correct answer)
- Document non-compliance and refer to a specialist
- Prescribe fewer medications to reduce the burden
Correct answer: Explore the patient's specific barriers to adherence using open-ended questions
Exploring barriers collaboratively identifies modifiable factors such as cost, side effects, or misunderstanding.
Question 4: During a consultation, a patient becomes tearful. The physician should respond by:
- Continuing the history to maintain appointment efficiency
- Handing the patient a tissue and waiting silently for them to compose themselves
- Acknowledging the emotion and pausing to allow the patient to express themselves (Correct answer)
- Immediately offering a referral to a mental health professional
Correct answer: Acknowledging the emotion and pausing to allow the patient to express themselves
Acknowledging emotion (e.g., 'I can see this is very difficult') validates the patient's experience and builds rapport.
Question 5: A physician uses the phrase 'Your myocardial infarction risk is elevated.' A patient nods but later cannot explain what was discussed. This illustrates:
- Patient non-compliance with discharge instructions
- The consequences of using medical jargon that exceeds patient health literacy (Correct answer)
- The need for written materials to supplement all consultations
- Normal forgetting due to anxiety in clinical settings
Correct answer: The consequences of using medical jargon that exceeds patient health literacy
Jargon creates a comprehension gap; the 'teach-back' method and plain language prevent this outcome.
Question 6: Which element of the SPIKES protocol specifically addresses assessing what the patient already knows before delivering bad news?
- Setting up the interview (S)
- Patient's Perception (P) (Correct answer)
- Invitation to share information (I)
- Knowledge transmission (K)
Correct answer: Patient's Perception (P)
The 'Perception' step involves asking the patient what they already understand about their condition before adding new information.
Question 7: A patient refuses a recommended blood transfusion based on religious beliefs. The physician should:
- Obtain a court order to proceed with the transfusion in an emergency
- Respect the refusal, document it, and explore alternative treatments with the patient (Correct answer)
- Contact the patient's next-of-kin to obtain consent on the patient's behalf
- Discharge the patient for refusing medical advice
Correct answer: Respect the refusal, document it, and explore alternative treatments with the patient
Respecting autonomous refusal by a competent adult is an ethical and legal obligation, even if the physician disagrees.
GAMSAT Patient Communication Skills 2
A patient with limited English proficiency arrives for a follow-up appointment without their usual interpreter.
The most appropriate action is to: