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CLINICAL
COMMUNICATION
SKILLS
IN
MEDICINE
A
P R I M E R
F O R
M R C P
P A C E S
ERNEST
SURESH
0
masterpass
^
CRC
Press
Taylor
&
Francis
Group
Clinical Communication Skills
in Medicine
This book takes readers through 45 challenging scenarios to teach communication skills in
medicine. It follows the revised format of the Practical Assessment of Clinical Examination
Skills (PACES) exam conducted by the Royal College of Physicians in the UK, which tests
communication skills twice in two separate stations. As most scenarios in this book have
been created in an acute medical unit setting, the approach followed should also appeal to
senior medical students and trainees in internal medicine and general practice at all levels.
Readers will learn:
• How to convey abnormal test results and break bad news
• How to discuss the diagnosis of a chronic disease and negotiate a management plan
• How to communicate with patients who pose an ethical dilemma
• How to communicate with challenging patients and relatives
• What to tell patients or relatives when things go wrong
• How to communicate with patients and relatives regarding end-of-life issues
Key Features:
• Takes readers through a simple, step-by-step approach to skilfully dealing with common
challenging communication scenarios they face in their daily practice
• Guides readers on how to communicate in layman’s terms without using medical jargon,
as it is fully dialogued, proving particularly helpful to non-UK candidates whose rst
language is not English
• Simplies several complex ethical and medicolegal principles, such as treatment of
patients lacking capacity, dealing with patients who refuse consent, condentiality,
counselling a non-compliant patient, basic genetic counselling, management of patients
who demand non-indicated investigations or treatments, open disclosure after a medical
error, preparing an advance decision and lasting power of attorney, issues around brain
death and organ donation, tube feeding, ‘Do Not Attempt Resuscitation’ (DNAR)
orders, and referral to the coroner.
The Final FRCA Constructed Response Questions
APractical Study Guide, 2E
Elizabeth Combeer, Mitul Patel
Diagnostic EMQs
AComprehensive Collection for Medical Examinations
Syed Hussain, Umber Rind, Jawed Noori, Yasmean Kalam, Haseeb Ata, Emanuel
Papageorgiou
Passing the Final FFICM
High-Yield Facts for the MCQ& OSCE Exams
Muzzammil Ali
Cases in Haematology
For the MLA and PLAB
Aaron Niblock
Postgraduate Ophthalmology Exam Success
Maneck Nicholson,Anjali Nicholson,Syed Faraaz Hussain
Pass the MRCP (SCE) Neurology Revision Guide
Dhananjay Gupta
Advanced ENT MCQs
Training to Pass the FRCS (ORL-HNS) Part 1
Peter Kullar, Jameel Muzaffar, Joseph Manjaly
Clinical Communication Skills in Medicine
APrimer for MRCP PACES
Ernest Suresh
MasterPass Series
For more information on this series, please visit
https://www.routledge.com/MasterPass/book-series/CRCMASPASS
Clinical Communication Skills
in Medicine
A Primer for MRCP PACES
Ernest Suresh MD, FRCP (London)
First edition published 2025
by CRC Press
2385 NW Executive Center Drive, Suite 320, Boca Raton FL 33431
and by CRC Press
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
CRC Press is an imprint of Taylor& Francis Group, LLC
© 2025 Ernest Suresh
This book contains information obtained from authentic and highly regarded sources. While all
reasonable efforts have been made to publish reliable data and information, neither the author[s] nor
the publisher can accept any legal responsibility or liability for any errors or omissions that may be
made. The publishers wish to make clear that any views or opinions expressed in this book by individual
editors, authors or contributors are personal to them and do not necessarily reect the views/opinions
of the publishers. The information or guidance contained in this book is intended for use by medical,
scientic or health-care professionals and is provided strictly as a supplement to the medical or other
professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s
instructions and the appropriate best practice guidelines. Because of the rapid advances in medical
science, any information or advice on dosages, procedures or diagnoses should be independently veried.
The reader is strongly urged to consult the relevant national drug formulary and the drug companies’
and device or material manufacturers’ printed instructions, and their websites, before administering
or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate
whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is
the sole responsibility of the medical professional to make his or her own professional judgements, so
as to advise and treat patients appropriately. The authors and publishers have also attempted to trace
the copyright holders of all material reproduced in this publication and apologize to copyright holders
if permission to publish in this form has not been obtained. If any copyright material has not been
acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced,
transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying, microlming, and recording, or in any information storage
or retrieval system, without written permission from the publishers.
For permission to photocopy or use material electronically from this work, access www.copyright.com
or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-
750-8400. For works that are not available on CCC please contact mpkbookspermissions@tandf.co.uk
Trademark notice: Product or corporate names may be trademarks or registered trademarks
and are used only for identication and explanation without intent to infringe.
ISBN: 978-1-032-87567-5
ISBN: 978-1-032-87566-8
ISBN: 978-1-003-53333-7
DOI: 10.1201/9781003533337
Typeset in Sabon
by Apex CoVantage, LLC
v
Preface ix
About the Author xiii
SECTION I
Conveying Abnormal Test Results
Case 1 The 51-Year-Old Woman with a Possible Brain Tumour 3
Case 2 The 22-Year-Old Woman with Type 1 Diabetes 8
Case 3 The 28-Year-Old Woman with a Positive HIV Test Result 13
Case 4 The 66-Year-Old Man with Advanced Pancreatic Cancer 18
Case 5 The 74-Year-Old Man with Acute Myeloid Leukaemia 23
Case 6 The 27-Year-Old Woman with Possible Coeliac Disease 27
Case 7 The 30-Year-Old Woman with Tuberculosis 32
Case 8 The 34-Year-Old Man with Hypertrophic Cardiomyopathy 37
SECTION II
Counselling on Disease Management
Case 9 The 22-Year-Old Man with Recurrent Episodes of Fainting 45
Case 10 The 24-Year-Old Pregnant Woman with Suspected Pulmonary
Embolism 50
Contents
vi Contents
Case 11 The 37-Year-Old Woman with Functional Dyspepsia 55
Case 12 The 46-Year-Old Man with Poorly Controlled Diabetes Mellitus 59
Case 13 The 78-Year-Old Woman with Hyponatraemia 63
Case 14 The 26-Year-Old Woman Who Has Had an Anaphylactic
Reaction 68
Case 15 The 48-Year-Old Man with Alcohol Use Disorder 73
Case 16 The 28-Year-Old Woman with Possible Lupus Nephritis 78
SECTION III
Capacity, Consent, and Confidentiality
Case 17 The 19-Year-Old Girl Whose Father Objects to a Lumbar
Puncture 85
Case 18 The 66-Year-Old Man Who Does Not Wish to Start Dialysis 91
Case 19 The 33-Year-Old Man Who Is Refusing the
HIV Test 96
Case 20 The 52-Year-Old Man Who Wants to Get Discharged against
Medical Advice 101
Case 21 The 77-Year-Old Man Whose Daughter Asks You Not to
Reveal the Diagnosis of Cancer to Him 106
Case 22 The 37-Year-Old Man with Gonorrhoea Who Asks You Not to
Tell His Wife about His Diagnosis 111
SECTION IV
Challenging Patients and Relatives
Case 23 The 26-Year-Old Man Who Is Asking to Be Tested for
Huntington’s Disease 119
Contents vii
Case 24 The 46-Year-Old Man Who Is Not Compliant with His
Anti-Hypertensive Medication 124
Case 25 The 65-Year-Old Woman Who Wants to Try Herbal Treatment
for Her Lymphoma 129
Case 26 The 24-Year-Old Man with Difcult Asthma 134
Case 27 The 63-Year-Old Woman Whose Husband Asks You Not to
Discharge Her 139
Case 28 The 42-Year-Old Man with Non-Specic Back Pain Who
Demands a Scan 143
Case 29 The 47-Year-Old Man Who Is Demanding Strong Opioids for
His Chronic Back Pain 148
Case 30 The 43-Year-Old Woman with No Diagnosis Despite Extensive
Evaluation 152
Case 31 The 66-Year-Old Man Whose Sister Does Not Agree with Your
Diagnosis 156
SECTION V
When Things Go Wrong
Case 32 The 68-Year-Old Man Whose Stroke Was Not Diagnosed in Time 163
Case 33 The 74-Year-Old Woman Who Has Suffered Harm Because of a
Medication Error 169
Case 34 The 78-Year-Old Man Who Fell Off His Bed in the Ward 174
Case 35 The 73-Year-Old Man Who Was Exposed to COVID in the Hospital 179
Case 36 The 27-Year-Old Woman with a Severe Allergic Reaction to
Sulfasalazine 185
Case 37 The 69-Year-Old Woman Whose Cord Compression Was Not
Diagnosed in Time 191
viii Contents
SECTION VI
End-of-Life Issues
Case 38 The 69-Year-Old Woman Who Wants to Make a Living Will 199
Case 39 The 82-Year-Old Woman for Whom the Medical Team Feels
That CPR Should Not Be Attempted 204
Case 40 The 68-Year-Old Man with Motor Neurone Disease Who
Needs Articial Feeding 208
Case 41 The 70-Year-Old Man with Acute Exacerbation of COPD 212
Case 42 The 81-Year-Old Man Who Is Terminally Ill 217
Case 43 The 45-Year-Old Man with Severe Brain Haemorrhage 221
Case 44 The 59-Year-Old Man Who Has Just Died from Myocardial
Infarction 226
Case 45 The 53-Year-Old Woman Whose Death Is Unexplained 230
Index 235
ix
This book takes you through 45 challenging cases in medicine to help you hone your skills in
communicating with patients or relatives and to understand the key ethical principles. Although
it is primarily targeted at those sitting for MRCP PACES, it should also appeal to senior under-
graduate medical students and trainees in internal medicine and general practice at all levels.
In the two ‘communication’ stations, examiners will test four different skills, including (1)
clinical communication, (2) managing patients’ concerns, (3) clinical judgement, and (4)
maintaining patient welfare. The scenarios are chosen to test your skills in (1) conveying an
abnormal test result or breaking bad news, (2) counselling about a disease or negotiating a
management plan, (3) handling consent- and condentiality-related issues, (4) communicat-
ing with challenging patients or relatives, (5) dealing with medical error, and (6) discussing
end-of-life issues. The scenarios are carefully vetted by the College to ensure that you can
complete the task in ten minutes. On the day of the exam, the two examiners will calibrate
each scenario and agree on what should constitute a satisfactory performance for each skill.
You will be given ve minutes to read the scenario before entering the room. Ican’t empha-
sise enough how important it is to read the details of the case very carefully during that time.
You will receive an unsatisfactory mark if you give incorrect information to the patient (e.g.
If you say ‘Your cancer has spread throughout your belly’ when the scenario states that ‘the
scan reported liver metastases’). It is also important to clearly understand what you are being
asked to do. Consider the following example: the candidate’s task is to convey the diagno-
sis of tuberculosis to an anxious patient who was recently investigated extensively for her
weight loss and to discuss the next steps.
CANDIDATE (who did not I understand that you were recently diagnosed with tuberculosis. Iam
here to discuss the treatment.
PATIENT (who is shocked): What! Ihave been here for a week, and no one told me that Ihad
tuberculosis!
You can imagine how difcult it will be to get out of this mess. You will be spending the
rst few minutes trying to calm her down and apologising for the oversight, thus unneces-
sarily losing some valuable time. You may not have enough time left at the end to talk about
important issues, like isolation or testing for HIV, resulting in an unsatisfactory mark for
clinical communication, managing patients’ concerns, and clinical judgement (and possibly a
borderline for maintaining patient welfare).
You cannot (and should not) plan the entire conversation before you enter the station, as
it will largely depend on what the patient tells you, but it is a good idea to write down the
read the scenario properly):
Preface
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