OSCESup.com — Year 2 Communication Stations

OSCESup.com

Year 2
Communication Stations

4 practice stations with full mark schemes and actor scripts. History taking, breaking bad news, and shared decision making across cardio/resp, renal, neuro, and MSK.

4 stations 7 minutes each History taking Breaking bad news Shared decision making Year 2

SettingGP consultation room

Duration7 minutes

Your roleYear 2 medical student

PatientMr Dennis Hartley, 67

TaskFull haematuria history

Candidate Brief — Read outside the door

You are a Year 2 medical student on GP placement. Mr Dennis Hartley, 67, has booked an urgent appointment after noticing blood in his urine for the first time three days ago. He is otherwise fit and well as far as he knows.

Your task: Take a full history of his haematuria, explore associated urological and systemic symptoms, cover relevant background history, and screen for red flag features. At the end, the examiner will ask you: "What is your top differential and what would you do next?"

Y2 Expectation — Haematuria Red Flags

Painless haematuria in a man over 60 is bladder cancer until proven otherwise. You must explore: visible vs non-visible · pain · clots · frequency / dysuria / LUTS · systemic features (weight loss, night sweats, anorexia) · smoking history · occupational exposures (aniline dyes, rubber) · family history of renal / bladder cancer · anticoagulant use.

Key areas to cover

Onset, duration, timing — throughout stream, at start, at end?
Colour — bright red, dark, clots?
Painful or painless?
Associated LUTS — frequency, urgency, nocturia, poor stream, hesitancy, terminal dribbling
Systemic symptoms — weight loss, anorexia, fatigue, night sweats, fever
Smoking history — packs per year
Occupational history — chemical / dye exposure
Medications — anticoagulants, NSAIDs
Family history — urological cancers
PMHx — previous UTIs, renal stones, prostate disease

What the patient has (examiner only)

Painless visible haematuria × 3 days — bright red, throughout stream
No clots, no dysuria, no fever
Mild frequency — up 2× per night, but longstanding
No systemic symptoms initially — but admits 4kg weight loss over 3 months if asked
Smoked 20/day for 30 years — gave up age 58
Retired painter and decorator — solvent exposure for decades
On aspirin 75mg for AF — no warfarin
Uncle had bladder cancer
No previous urological problems

Score

0 / 20

Opening & ICE 2 marks

Introduces themselves appropriately, uses open question to begin1

Elicits ICE — what he thinks is causing it, what he is worried about ("are you concerned about anything in particular?"), what he is hoping for today1

Characterising the Haematuria 5 marks

Establishes onset and duration — when he first noticed it, how many times it has occurred1

Confirms visible (frank) vs non-visible (dipstick only) haematuria — asks if he actually saw blood1

Asks about the timing in the stream — initial (urethral), terminal (bladder neck), or throughout (bladder/kidney)1

Asks whether the haematuria is painful or painless — specifically asks about loin/flank pain, dysuria, or suprapubic discomfort1

Asks about clots in the urine — presence of clots suggests significant bleeding1

Associated Urological Symptoms 3 marks

Asks about LUTS — specifically frequency, urgency, nocturia, poor flow, hesitancy, incomplete emptying, terminal dribbling1

Asks about symptoms of infection — fever, rigors, dysuria, offensive smelling urine1

Asks about loin pain radiating to groin and vomiting — to screen for renal calculi1

Red Flag & Systemic Screening 4 marks

Asks about unexplained weight loss, anorexia, or fatigue1

Asks about smoking history — specifically quantifies pack years1

Asks about occupational history — chemical, dye, rubber, or industrial exposures1

Asks about family history of urological cancers, renal disease, or haematuria1

Background History 3 marks

Drug history — anticoagulants, antiplatelets, NSAIDs (can cause or worsen haematuria)1

Past medical history — previous UTIs, renal stones, prostate problems, hypertension, diabetes1

Social history — who he lives with, functional impact of symptoms, alcohol1

Global Communication & Examiner Question 3 marks

History flows naturally — follows patient's leads, does not work through a rigid checklist1

When weight loss is revealed, candidate follows up rather than moving on — acknowledges this is significant1

Examiner question: names bladder transitional cell carcinoma as top differential given age, sex, smoking history, occupational exposure, and painless haematuria — and states urgent 2-week-wait referral to urology is required1

Pass Thresholds — 20 marks total

Pass: ≥ 14/20 — haematuria characterised, LUTS and red flags screened, smoking and occupational history taken, correct differential given

Borderline: 10–13/20 — haematuria history adequate but red flags or occupational history not explored

Fail: < 10/20 — or weight loss mentioned by patient but not followed up; or candidate fails to identify this as an urgent referral

Actor: Mr Dennis Hartley, 67, retired painter and decorator. Calm and matter-of-fact but quietly frightened — he's seen a friend go through cancer and knows this could be serious. He doesn't want to catastrophise but he's been googling. He won't volunteer his weight loss or occupational history unless directly asked. He's relieved when the candidate takes it seriously.

Opening

Dennis"Morning. So, a bit embarrassing this — but I've had blood in my urine. Three days now. Came out of nowhere. I've never had anything like it before."

When asked to describe the haematuria

Dennis"It was bright red — actually red, not just a tinge. Happened three times. All the way through, not just at the start."

Dennis"No pain at all. I kept waiting for it to hurt but it didn't. That's what worried me more, if I'm honest."

If asked about LUTS

Dennis"I do get up twice in the night to go — but that's been the case for a few years. Nothing new. No burning, no urgency, no problems with the flow really."

If asked about systemic symptoms / weight loss

Dennis[Pauses, slightly embarrassed]

Dennis"Actually — now you mention it, my trousers have been feeling loose. My wife said something a few weeks back. I'd say maybe four kilos in the last couple of months. I just thought I wasn't eating as much."

If asked about smoking

Dennis"I used to smoke — twenty a day for about thirty years. Gave up nine years ago."

If asked about occupation / chemicals

Dennis"Painter and decorator. Forty years of it. Lots of solvents, strippers, that sort of thing. I never thought much about it at the time."

If asked ICE / what he thinks it is

Dennis"My mate Derek had bladder cancer last year. He had blood in his urine too. I suppose that's what I'm worried about — that it might be something like that."

If candidate doesn't ask about weight loss or occupation

Do not volunteer — examiner will note it as a missed red flag.
If wrapping up without asking: "Is there anything else you need to know? I wasn't sure if my old job was relevant."

SettingNeurology ward side room

Duration7 minutes

Your roleYear 2 medical student

PatientMrs Patricia Osei, 71

TaskBreak diagnosis of ischaemic stroke

Candidate Brief — Read outside the door

Mrs Patricia Osei, 71, was admitted 48 hours ago after her husband found her confused with weakness down her right side. She has been on the stroke unit while investigations were completed. Her CT and MRI have confirmed a left-sided ischaemic stroke. She has been treated with thrombolysis and is stable. She has some mild right arm weakness remaining but is otherwise improving.

Mrs Osei has not yet been formally told her diagnosis. She has been asking the nursing staff what is wrong with her. The consultant has asked you to sit with her and break the news under supervision.

Your task: Break the diagnosis of ischaemic stroke. Explain what a stroke is in lay terms, what caused her symptoms, and what happens next. Allow her to respond and deal with her reaction. You are not expected to give a detailed prognosis.

Y2 Breaking Bad News — SPIKES Framework

Setting (private, tissues, sitting down) · Perception (what does she already know?) · Invitation (does she want to know?) · Knowledge (give information in chunks, use lay language) · Empathy (respond to emotion before continuing) · Strategy & Summary (what happens next, who she can speak to)

Key information to convey

She has had a stroke — a blood clot blocked a blood vessel in her brain
This caused the confusion and right-sided weakness
She received thrombolysis — a clot-dissolving treatment — which helped
She is stable and improving
She will have a stroke rehabilitation team — physio, OT, speech therapy if needed
She will need medication to prevent another stroke — antiplatelet, statin, blood pressure control
It is natural to feel shocked and to have questions
She can speak to the consultant and to nurses at any time

Her reactions (actor choices)

Initially calm — she suspected something serious
Asks: "Will I get back to normal? I play bowls every Tuesday."
Asks: "Will it happen again?"
Becomes emotional if not given space to respond
Asks about driving — she drives her grandchildren to school
Asks: "Why did this happen to me? I've always been healthy."

Score

0 / 20

Setting & Preparation 3 marks

Introduces themselves, confirms patient's name, and checks she is comfortable — offers to get a glass of water or ensure she is sitting comfortably1

Checks what she already knows / has been told — "What have the nurses or doctors said to you so far?"1

Checks if she would like anyone with her — mentions that her husband or family could be present if she wishes1

Delivering the Diagnosis 5 marks

Gives a warning shot before delivering the news — "I'm afraid the results have shown something significant"1

States the diagnosis clearly — uses the word "stroke" and does not soften it to the point of ambiguity1

Explains what a stroke is in plain language — a blood clot blocked a blood vessel in her brain, reducing blood flow and causing her symptoms1

Explains that she received treatment (thrombolysis / clot-dissolving medication) and that this helped — explains why she is improving1

Pauses after delivering the diagnosis to allow her to react — does not rush to fill the silence with more information1

Responding to Emotion 4 marks

Acknowledges her emotional response empathetically — "This is a lot to take in" / "It's completely understandable to feel shocked"1

Addresses her question about returning to normal / bowls — gives a balanced, honest answer without being falsely reassuring ("many people do recover well, but it's too early to say exactly how much…")1

Addresses the driving question honestly — explains that DVLA rules require her to stop driving for at least one month after a stroke and she will need to inform her insurance; does not say "you can probably drive soon" without caveating1

Addresses risk of recurrence — explains that the team will work to reduce the risk with medication and investigations into the cause; does not say "it won't happen again"1

Next Steps & Closing 4 marks

Explains that a stroke rehabilitation team will be involved — physiotherapist, occupational therapist, and speech and language therapist if needed1

Mentions medication to prevent further stroke — antiplatelet therapy and statin at minimum, framed as "we will start some medicines to protect you going forward"1

Offers to get the consultant to come and speak with her in more detail — and gives her the opportunity to write down questions1

Closes empathetically — checks she is alright before leaving, ensures she knows how to call for a nurse, and suggests her husband could come in1

Global Communication 4 marks

Uses no jargon or explains any medical terms used — "ischaemic" is not used without explanation1

Gives information in manageable chunks — does not deliver everything at once; checks understanding along the way1

Tone is warm and calm throughout — does not appear rushed, maintains eye contact (or body language equivalent), does not sit behind a desk1

Patient felt heard and not abandoned at the end of the consultation — examiner global impression that this was a compassionate and appropriate breaking bad news encounter1

Pass Thresholds — 20 marks total

Pass: ≥ 14/20 — diagnosis delivered clearly using SPIKES structure, emotion acknowledged, next steps covered, driving addressed

Borderline: 10–13/20 — diagnosis given but too clinical, patient's emotion not properly acknowledged, or unrealistic reassurance given

Fail: < 10/20 — or diagnosis never stated clearly; or candidate falsely reassures patient about driving or recurrence

Actor: Mrs Patricia Osei, 71, retired teacher. Dignified and composed, but visibly anxious — she's been lying in a hospital bed for 48 hours and nobody has told her what's wrong. She suspects it's serious. She is not angry, but she is frightened. She responds warmly to a candidate who is calm and kind. She becomes emotional when told the diagnosis but holds herself together. Her grandchildren are her main concern.

Opening — when candidate enters

Patricia"Oh, hello. They said someone was coming to talk to me. I've been waiting — nobody has really told me what's going on. I know it must have been something with my brain."

When asked what she already knows

Patricia"The nurses said the scan results were back but that the doctor would explain. I know I came in with weakness in my arm and I was a bit confused, they said. My husband found me. I've been putting two and two together."

When the diagnosis is delivered

Patricia[Quiet for a moment. Nods slowly.]

Patricia"A stroke. Yes. I thought as much."

Patricia[After a pause — eyes fill but she doesn't cry]

Patricia"Will I get back to normal? I play bowls every Tuesday. I know that sounds silly but it matters to me."

Questions to ask during the consultation (pick 2–3)

Patricia"Will it happen again? That's what worries me. My sister had a stroke and then she had another one."

Patricia"I drive my grandchildren to school on Fridays. Am I going to be able to drive?"

Patricia"Why did this happen? I've always been fairly healthy. I walk every day."

If candidate handles driving question poorly (falsely reassures)

Patricia"So I'll be able to drive soon? My granddaughter is relying on me — I need to know for certain."

If candidate is cold, rushed, or gives false reassurance

"You're telling me it'll all be fine but I don't feel like you really mean it."
"Can you just tell me straight — am I going to be alright?"

SettingGP consultation room

Duration7 minutes

Your roleYear 2 medical student

PatientMrs Shirley Dawson, 64

TaskFull breathlessness history

Candidate Brief — Read outside the door

You are a Year 2 medical student on GP placement. Mrs Shirley Dawson, 64, has come in complaining of worsening breathlessness over the last three months. She has no previous cardiac or respiratory diagnosis on record.

Your task: Take a full history of her breathlessness. You are expected to explore both cardiac and respiratory causes systematically, use appropriate grading of functional limitation, and screen for red flags. At the end, the examiner will ask: "Give two differentials and explain your reasoning."

Y2 Expectation — Breathlessness Differentials

By Year 2 you should be exploring both cardiac and respiratory causes in parallel, not just one system. Key discriminators: onset and progression · positional worsening (orthopnoea / PND = cardiac) · wheeze / cough character (respiratory) · ankle oedema · chest pain · palpitations · smoking history · occupational exposure · exercise tolerance (MRC dyspnoea scale).

Key areas to cover

Onset — sudden vs gradual; duration; progression
Exercise tolerance — MRC grade (what stops her?)
Orthopnoea — pillows at night; PND
Ankle swelling — bilateral or unilateral
Cough — productive or dry; haemoptysis
Wheeze — time of day, triggers
Chest pain or tightness on exertion
Palpitations or dizziness
Smoking history — pack years
Occupational / environmental exposure — dust, birds, chemicals
Systemic — weight loss, night sweats, fever
PMHx — previous cardiac / respiratory disease; DVT / PE risk

What the patient has (examiner only)

3-month progressive breathlessness — MRC grade 3 (stops on level ground after 100m)
Dry cough for 6 weeks — no haemoptysis
Now sleeping on 3 pillows — new over 4 weeks; not asked about this until probed
Bilateral ankle swelling — worse at end of day
No wheeze; no chest pain; mild palpitations on exertion
BMI 34; ex-smoker 15 pack-years; gave up 10 years ago
Kept pigeons for 20 years ("just sold them six months ago")
No fever or weight loss
Husband had heart failure — "I know what that looks like"
PMHx: hypertension (on amlodipine, ramipril)

Score

0 / 20

Opening & ICE 2 marks

Introduces themselves, open question to begin, allows patient to give her account1

Elicits ICE — what she thinks is causing it, what she is most worried about, what she hopes for from the appointment1

Characterising the Breathlessness 4 marks

Establishes onset and progression — when it started, whether it has worsened over time, how rapidly1

Grades functional limitation — asks what she can and cannot do now vs three months ago; quantifies distance or activity level (MRC dyspnoea scale)1

Asks about orthopnoea — how many pillows she sleeps on and whether this has changed; asks about waking at night gasping (PND)1

Asks about ankle oedema — bilateral vs unilateral, timing, extent, pitting1

Cardiac Symptoms 3 marks

Asks about chest pain or tightness on exertion — character and radiation1

Asks about palpitations — frequency, associated dizziness, syncope1

Asks about cardiovascular risk factors — hypertension, diabetes, smoking, cholesterol, family history of heart disease1

Respiratory Symptoms & Exposures 4 marks

Asks about cough — dry vs productive, duration, haemoptysis1

Asks about wheeze — timing, triggers, nocturnal1

Asks about smoking history — quantifies pack years1

Asks about occupational or environmental exposures — bird / animal keeping, dust, asbestos, chemicals; does not dismiss a non-standard hobby as irrelevant1

Background History & Examiner Question 4 marks

Drug history — asks specifically what she takes and whether any medications could cause cough (e.g. ACE inhibitor / ramipril)1

Past medical history — specifically asks about previous heart or lung conditions, hypertension, DVT/PE1

When pigeon keeping is mentioned, candidate asks follow-up questions — how long, recent contact, type of birds — and recognises this as clinically relevant (hypersensitivity pneumonitis / bird fancier's lung)1

Examiner question: gives two plausible differentials with reasoning — e.g. heart failure (orthopnoea, ankle oedema, hypertension, cardiac history) AND hypersensitivity pneumonitis / bird fancier's lung (pigeon exposure, dry cough, progressive dyspnoea)1

Global Communication 3 marks

Explores both cardiac and respiratory systems — does not focus exclusively on one1

Responds appropriately to patient's ICE — acknowledges her concern about heart failure (her husband's condition)1

History used to guide differentials naturally — candidate's line of questioning reflects clinical reasoning, not just a list of questions1

Pass Thresholds — 20 marks total

Pass: ≥ 14/20 — both cardiac and respiratory explored, orthopnoea and ankle oedema covered, bird exposure identified, two reasonable differentials given

Borderline: 10–13/20 — adequate history but pigeon history missed or not identified as significant; only one system explored thoroughly

Fail: < 10/20 — or orthopnoea not explored; or pigeon exposure mentioned but dismissed; or only one differential given

Actor: Mrs Shirley Dawson, 64, retired school dinner lady. Warm and chatty. She tends to downplay her symptoms ("I'm not one to make a fuss") and attributes her breathlessness to getting older and being overweight. She knows her husband had heart failure and is quietly terrified it's the same thing. She won't mention the pigeons unless asked about hobbies or animals — she doesn't think it's relevant. She responds well to a thorough candidate.

Opening

Shirley"Hello love. I wasn't sure whether to come in, to be honest. I've just been getting more and more breathless and it's starting to get in the way. I thought it was just my weight but it seems to be getting worse."

When asked about exercise tolerance

Shirley"Three months ago I could walk to the shops — that's about ten minutes. Now I have to stop halfway. And going upstairs, I have to take it really slowly."

If asked about pillows / sleeping

Shirley"Actually — yes, I've been using three pillows lately. The last few weeks. I don't know why, I just find it easier to breathe sitting more upright. My husband used to do that."

If asked about ankle swelling

Shirley"My ankles are a bit puffy in the evening, yes. Both of them. I thought that was because I'm on my feet all day but I'm retired now so that can't be it."

If asked about hobbies / animals / birds

Shirley"I used to keep pigeons — homing pigeons, in a loft in the back garden. Twenty years I had them. I only sold them about six months ago. Why, is that relevant?"

If asked about ICE

Shirley"My husband had heart failure. He ended up in hospital three times with it. I know what it looks like. That's what I think I've got. That's what I'm scared of."

If asked about medications

Shirley"I take amlodipine and ramipril — for my blood pressure. Been on them for five years. Oh, and I've had this dry cough for a few weeks too. I thought it was a cold but it hasn't shifted."

If candidate doesn't ask about pets / hobbies / environment

Do not volunteer the pigeon history — examiner will note this as a missed occupational/environmental exposure.
If wrapping up: "Is there anything else you need to know? I wasn't sure if my old hobby was relevant."

SettingOrthopaedic outpatient clinic

Duration7 minutes

Your roleYear 2 medical student (supervised)

PatientMr Raymond Cole, 74

TaskDiscuss TKR vs conservative management

Candidate Brief — Read outside the door

Mr Raymond Cole, 74, has severe right knee osteoarthritis confirmed on X-ray. He has trialled analgesia, physiotherapy and two steroid injections over the past two years with limited benefit. He has been referred for consideration of a total knee replacement (TKR) and has been seen by the consultant, who explained the options. He has been asked to speak with you to help him think through his decision.

His main concerns are around the recovery time and his fear of surgery. He lives alone and is a keen gardener. He is medically fit for surgery (no significant comorbidities).

Your task: Use a shared decision-making approach to explore his values and preferences, explain both options clearly and honestly, and help him reach a decision. You should not make the decision for him but should support him to consider what matters most to him.

Y2 SDM Expectation — Beyond Information Giving

At Year 2 you are expected to demonstrate that SDM is not just giving information — it requires eliciting what matters to the patient and using that to frame the discussion. Mr Cole lives alone and is a gardener: these are clinically and personally relevant. The option that is right for a 74-year-old who lives alone may differ from the option right for a 50-year-old athlete.

Total Knee Replacement (Surgery)

Major elective surgery under general or spinal anaesthetic
Replaces the damaged joint surfaces with metal and plastic components
Hospital stay: 2–4 days; full recovery 6–12 months
Will need physiotherapy, walking aids, and support at home during recovery
Risks: infection (1–2%), DVT / PE, blood loss, nerve damage, implant failure, anaesthetic risk
90% of patients have significant improvement in pain and function
Implant lasts 15–20 years in most patients
He will need help at home for the first 6–8 weeks — relevant given he lives alone

Conservative Management (Non-surgical)

Optimised analgesia — paracetamol, topical NSAIDs, oral NSAIDs (with caution), opioids if severe
Further physiotherapy — strengthening programme
Further steroid or hyaluronic acid injections
Weight management if BMI elevated
Mobility aids — walking stick / frame
Avoids surgical risk but does not treat underlying joint destruction
Likely to provide temporary relief only; symptoms will progress
He can choose surgery at a later date if conservative treatment fails again

Score

0 / 20

Opening & Eliciting What Matters 4 marks

Introduces themselves and confirms patient's name; checks what he already understands about his options1

Asks what matters most to him — what he wants to be able to do that he currently can't; explores how the knee is affecting his life and specifically his gardening1

Asks about his concerns — specifically explores his fear of surgery and what exactly worries him about it (the operation itself, anaesthetic, recovery, pain)1

Asks specifically about his home situation — lives alone, who could help him during recovery, whether he has family nearby1

Explaining Conservative Management 3 marks

Explains what further conservative treatment involves — optimised analgesia, physio, possible further injections1

Is honest about the limitations — does not treat the underlying joint destruction; likely to provide temporary relief; symptoms will continue to progress1

Explains this does not close the door on surgery — he can still opt for TKR later if needed1

Explaining Knee Replacement Surgery 4 marks

Explains TKR in plain language — damaged surfaces of the joint are replaced, allows the joint to move without the damaged bone rubbing1

Explains the recovery honestly — hospital 2–4 days, walking aids needed, full recovery 6–12 months; specifically addresses that he will need support at home for the first 6–8 weeks1

Explains surgical risks honestly and without being alarming — infection, DVT, blood loss, anaesthetic risks; frames these as rare but real1

Explains the benefit — 90% of patients get significant pain relief and improved function; implant lasts 15–20 years; likely to allow return to gentle gardening in time1

SDM Process & Closing 5 marks

Links the information explicitly to his personal context — e.g. "Given that you live alone, the recovery support is something we'd need to plan carefully before going ahead"1

Explicitly invites his preference — "Having heard all that, where are your thoughts now? Is there one option that feels right for you?"1

Addresses his fear of surgery directly — acknowledges it is natural to be worried, asks what specifically worries him, and responds to that specific concern1

Offers time to decide — does not pressure an immediate decision; suggests he could think about it, discuss with family, or come back with questions1

Mentions that the team can help plan social support for recovery if he opts for surgery — social work / OT referral, family support, discharge planning1

Global Communication 4 marks

Both options presented with equal weight — not implicitly pushing one; patient clearly felt he had a genuine choice1

No jargon used — or all medical terms explained (e.g. "DVT — a blood clot in the leg")1

Patient's personal context (living alone, gardening, fear of surgery) was woven throughout the consultation — not just noted once and forgotten1

Patient left feeling respected and supported — examiner global impression that this was a genuinely patient-centred consultation, not just informed consent1

Pass Thresholds — 20 marks total

Pass: ≥ 14/20 — both options explained with pros/cons, patient's context linked to decision, preference elicited, fear of surgery addressed

Borderline: 10–13/20 — options covered but living-alone context not used to guide discussion; or patient felt guided towards surgery

Fail: < 10/20 — or only one option explained; or patient's fear dismissed without acknowledgement; or decision effectively made for patient

Actor: Mr Raymond Cole, 74, retired postman. Mild-mannered and polite — slightly old-fashioned in his manner. He has been managing his knee pain for years and is used to getting on with it. He is frightened of going under the knife and will need careful, respectful reassurance. He is not dramatic — his fear is quiet, not agitated. He responds well to a candidate who takes him seriously and acknowledges that his circumstances (living alone) are a real practical concern. He is willing to consider surgery if the candidate helps him think through the recovery support.

Opening

Raymond"Morning. So — I've been told I need to make a decision about this knee business. I've not slept well thinking about it. I'm not sure surgery is for me, if I'm honest. I've never had an operation in my life."

When asked what matters most / about his daily life

Raymond"My garden. That's my life — I'm out there every day from spring to autumn. I can barely kneel down now. And the walking — I can only manage about five minutes before the pain gets bad."

When asked about his concern about surgery

Raymond"It's the anaesthetic mainly. My brother went in for a hip operation a few years ago and had a bad reaction. He was fine in the end, but it shook me up. And I live on my own — who's going to look after me?"

Questions to raise during consultation (pick 1–2)

Raymond"How long would I be in hospital? I've got a cat — I'd need to sort someone out."

Raymond"What happens if I just carry on as I am? Is that not an option?"

Raymond"My daughter keeps saying I should just go ahead with it. But it's my knee, isn't it."

If candidate explains both options well and addresses living-alone concern

Raymond"So there are people who could help with the recovery side of things? I didn't realise that. My daughter is in Sheffield but she said she'd come down. Maybe it's not as impossible as I thought."

Raymond"I think I'd like to have a think and maybe talk to my daughter first. But you've helped me see it a bit more clearly."

If candidate doesn't ask about his home situation or just gives information without exploring values

"You're telling me the facts but I still don't know what's right for me. What would you do?"
"I live on my own — has anyone thought about that? How am I supposed to manage?"