In this MRCS Part B scenario you are the on call surgical registrar. Please talk to Mr Donald, find out why he wants to go home, and explain why he must stay in.
Self discharge is a common scenario you will have experienced in the hospital itself. In the OSCE it is more formalised and you need to display a range of different communication skills to score full marks - and remember these marks are as valuable as the marks for anatomy, so spend time practicing!
It is important to spend sometime establishing why he wants to be discharged. If there is something you can change to make him agree to stay, you need to find out about it and if possible make it happen.
You then need to explain why going home is not medically advisable. Stress that the consultant wants him observed which means there is a serious possibility that he could get worse. You must stress that if he goes home he could become seriously unwell and even die.
Ask him to repeat what you have told him back to you to check capacity to make this decision. Remember that if he can understand the risks associated with him going home, retain that information weigh it up and communicate his decision back to you then regardless of whether it is a sensible decision, you must accept it.
As you cannot discharge him medically, you should explain that he needs to self-discharge, explaining that he is responsible for the consequences of the decision.
He must sign a legal document that states that the clinical scenario was explained, continued admission was medically advised, the potential consequences of self-discharge have been explained and the patient takes responsibility for adverse outcomes.
As he is self-discharging, you cannot give him any take home medication; however you can advise him to buy analgesia from a chemist.
Once it is established that he will self-discharge, you should give him information on what to look out for and what to do if the symptoms return or worsen, suggesting that he should attend A&E and ask them to contact the surgical SHO directly.
You can arrange for the patient to be seen if he is able to return the next day.
You must inform the consultant and bed manager as soon as possible about the outcome of the consultation.
Remember to display appropriate body language throughout the scenario. This is best done by forgetting that this is an actor, and imagine instead that this is a real patient who is under your care. The much used mark scheme phrase "ideas, concerns and expectations" wants you to find out what the patient thinks about the current issue, what is worrying them and what they want from you. Covering these issues is a good way to demonstrate your empathy in the communication station and score the communication marks in other stations.
Summarise the discussion and check their understanding to close the consultation.