Consulting with disabled patients can be a problem area for some CSA candidates. As every CSA exam day has to include an element of diversity, it would not be uncommon to find yourself consulting with a disabled patient during the exam.
How it is covered in the CSA exam
The patient may be obviously physically disabled, and appear on crutches or in a wheelchair. He or she may have had a long-term condition originating from birth, such as cerebral palsy, or may have acquired the condition later in life, for example, multiple sclerosis, or from sort kind of trauma.
It is also possible to have a blind or partially sighted patient, or a deaf or hard-of-hearing patient. You may also be presented with a patient who has a learning disability - this could be a patient of any age.
What to do in the exam
It will often be stated in the candidate briefing notes that the patient is blind, deaf, or disabled in some way, so take this into account when you are preparing yourself in the time that you have between cases.
Think through any likely communication difficulties and how you are going to deal with them. For example, with deaf patients you will need to establish their degree of deafness and whether they can lip read. If they can, make sure that you position yourself in a way so they can see your face clearly when you are talking to them.
If they are blind, think how you might need to help them in the consultation room. It will also be of little use giving them a patient information leaflet unless you have established whether they have somebody at home to read it to them.
With all disabilities, it is a good idea to demonstrate an appreciation of the social and psychological impact of the problem on the patient. This is something that you may want to explore in more detail when taking a history.
How to prepare
GP registrars do not necessarily see the same patient mix as their trainers, and it may be that you have less experience of meeting and dealing with disabled patients in real-life consultations. Discuss with your trainer opportunities to remedy this. The practice could help direct you to certain patients who have a disability when allocating home visits, or put you in touch with specific families.
You could sit in on a joint consultation with your trainer or another GP in the practice when they see a disabled patient. Read up on support services for certain kinds of disabilities, such as talking books and visual aids for the partially sighted. It is also worth having a working knowledge of any benefits or allowances available to the disabled.
With patients with learning disabilities, avoid the trap of diagnostic overshadowing and make sure you are aware of the fact that these patients have a higher incidence of physical problems, including epilepsy or visual and hearing difficulties.
- Dr Denney is an MRCGP examiner, and a GP in Edinburgh