A young mother comes with their 12-month-old child to your GP practice as a part of the routine immunisation schedule. However, the mother reveals that she decided not to vaccinate their child against measles, mumps and rubella (MMR) and appears to be anxious. What would you do?

❓ Why Is This Question Asked: 

Another common type of scenario given at medical school interviews is those involving anxious patients. It's not uncommon that patients become anxious when they have to put their trust in someone else, especially when it comes to their health or even life. Therefore, through exploring such scenarios, the interviewers want to gauge whether you have the right approach to be prepared for such situations, whether you are empathetic and compassionate, able to comfort an anxious person, notice and resolve any underlying issues they may have, and whether you can handle their and your own emotions tactfully and respectfully. 

🧊 ICE Framework: 

There is a useful framework (which is actually taught at most medical schools) that can help you deal with such scenarios: ICE, which stands for Ideas, Concerns, Expectations.

💡 Ideas: First, you have to gauge the patient's current understanding of the situation. Gaining insight into their worldview will allow you to adjust the next steps in the conversation. In the scenario above, it may be worth inquiring whether the mother knows about the benefits of an MMR vaccine, the potential risks of the three diseases and the proven safety of the vaccine. Since their anxiety may stem from missing an important piece of information, it may prove useful to clarify any uncertainties they may have or generally leave them better informed. A more general question could be appropriate in other scenarios, such as "What do you think is happening?".

😟 Concerns: Furthermore, you have to dive deeper into the issue and understand the root of their worries. What is the specific reason the mother refuses to vaccinate their child? Is it due to ethical or religious reasons? Have they read something online, that they didn't fully understand, or that simply wasn't true? You can start with an open-ended question, such as: "Is there anything you are particularly worried about?".

❤️‍🩹 Expectations: Lastly, it may prove useful to you to understand the reason they came to you. Is there anything they are expecting from the consultation? Can they see any way to tackle the problem at hand?

✅ Anxious Patient Scenario: Top Interview Tips:

Give them time: While talking to patients, you have to give them sufficient time to speak, as the simple act of giving someone time to vent their emotions may calm them down. Furthermore, throughout such conversations, one has to be sensitive and empathetic so that the patient feels they are understood and taken seriously. Therefore, if you were to face a similar scenario in an MMI setting, make sure never to interrupt the actor and ask open questions to allow them to talk.

Rephrase: Whenever faced with a scenario, try to rephrase it to the interviewer at the beginning - it will help you make sure you remember all crucial details. If you miss something, the interviewer should correct you, but this shouldn't affect their assessment of your answer.

Gather information: Gather information before explaining your recommendations to the patient (ICE) This allows for a much more efficient conversation and ensures the patient’s concerns and queries are answered.

❌ Anxious Patient Scenario: Common Mistakes:

Forcing your opinion onto the patient. Whilst it is important that you inform the patient about the treatment so that they can make an informed decision, keep in mind that most patients have the autonomy to refuse even the most beneficial treatment or medicines. Therefore, you can try to acknowledge in your answer that whilst it is important to communicate your opinion to the patient, you cannot force it on them.

Rejecting patient's perception. Putting yourself in the patient’s shoes and acknowledging their worries may not only help you better understand the problem and take action accordingly but also allow you to better relate to their situation and show empathy. And that's especially crucial at times when patients are anxious, as they have to feel they are taken seriously and that they are taken care of.