OSCE Communication Skills 3 — Questions and Answers
Question 1: A patient asks you to keep their diagnosis secret from their spouse. What is the ethically appropriate response?
- Agree to confidentiality without qualification
- Explain that you must inform the spouse for their protection
- Respect the patient's confidentiality while clarifying any legal exceptions (Correct answer)
- Refer the patient to social work to handle the issue
Correct answer: Respect the patient's confidentiality while clarifying any legal exceptions
Confidentiality is a patient right, though clinicians must inform patients of legal exceptions such as mandatory reporting.
Question 2: Which type of question is most effective for opening a patient interview?
- 'Do you have chest pain?'
- 'Is the pain sharp or dull?'
- 'What brings you in today?' (Correct answer)
- 'How long has the pain been there?'
Correct answer: 'What brings you in today?'
Open-ended questions like 'What brings you in today?' allow patients to express concerns in their own words without anchoring their response.
Question 3: You are running behind schedule and a patient begins an elaborate social history. The best approach is to:
- Interrupt and redirect to the chief complaint
- Listen briefly, acknowledge, then gently refocus with a bridging statement (Correct answer)
- Let the patient finish and extend the appointment time
- Ask the patient to schedule a longer appointment
Correct answer: Listen briefly, acknowledge, then gently refocus with a bridging statement
A brief, empathetic bridging statement allows redirection without dismissing the patient's concerns.
Question 4: When communicating with an angry patient, which approach is most therapeutic?
- Match the patient's energy to demonstrate assertiveness
- Remain calm, validate their frustration, and explore the underlying concern (Correct answer)
- Set firm boundaries and end the interaction if necessary
- Apologize repeatedly to de-escalate the situation
Correct answer: Remain calm, validate their frustration, and explore the underlying concern
Staying calm, validating feelings, and identifying the root cause of anger is the most effective de-escalation strategy.
Question 5: A patient refuses to make eye contact and gives one-word answers. Which non-verbal communication adjustment is most appropriate?
- Move closer to establish connection
- Lower your body to the patient's level and reduce physical barriers (Correct answer)
- Ask directly why they seem uncomfortable
- Continue the interview normally to avoid making the patient self-conscious
Correct answer: Lower your body to the patient's level and reduce physical barriers
Reducing physical barriers and matching body level communicates openness and reduces hierarchical distance.
Question 6: In an OSCE, a patient says they have been 'feeling down' for weeks. The most appropriate follow-up is:
- 'Have you been diagnosed with depression before?'
- 'Can you tell me more about what feeling down has been like for you?' (Correct answer)
- 'Are you sleeping and eating normally?'
- 'On a scale of 1-10, how depressed do you feel?'
Correct answer: 'Can you tell me more about what feeling down has been like for you?'
An open-ended follow-up invites elaboration and helps the patient articulate the nature and impact of their symptoms.
Question 7: When transitioning from history-taking to the physical exam, what is the most important communication step?
- Wash your hands visibly to signal readiness
- Summarize your findings and ask if there is anything else the patient wants to add (Correct answer)
- Ask the patient to undress while you step out
- Begin the exam without comment to maintain efficiency
Correct answer: Summarize your findings and ask if there is anything else the patient wants to add
Summarizing and inviting additional concerns ensures completeness and demonstrates respect before shifting to the physical examination.
OSCE Communication Skills 3
A patient asks you to keep their diagnosis secret from their spouse.
What is the ethically appropriate response?