Paeds Cases · professional-practice-and-evidence
Counselling a family toward high-value care — OSCE
OSCE on explaining restraint and shared decision-making to a family requesting a low-value test and treatment.
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Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A parent brings their febrile, snuffling three-year-old with a viral upper respiratory infection and asks for 'the antibiotics that worked last time'; they are anxious, have read online that antibiotics prevent complications, and worry that not prescribing means their child is not being taken seriously.
Station brief (8–10 minutes)
Help the parent reach a high-value decision for their child by explaining why an antibiotic is not indicated, addressing their anxiety and the online information, and offering a clear safety-net. Demonstrate stewardship as patient-centred good medicine rather than cost-cutting. Do not invent specific drug doses or local cost figures. [1]
References6ShowHide
- [1]Cassel CK, Guest JA Choosing wisely: helping physicians and patients make smart decisions about their care JAMA, 2012.PMID 22492759
- [5]Coon ER, Quinonez RA, Moyer VA, et al. Overdiagnosis: how our compulsion for diagnosis may be harming children Pediatrics, 2014.PMID 25287462
- [8]Elshaug AG, Rosenthal MB, Lavis JN, et al. Levers for addressing medical underuse and overuse: achieving high-value health care Lancet, 2017.PMID 28077228
- [9]Morgan DJ, Leppin AL, Smith CD, et al. A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient-Clinician Interaction Journal of hospital medicine, 2017.PMID 28459906
- [13]Colla CH Swimming against the current--what might work to reduce low-value care? New England Journal of Medicine, 2014.PMID 25271601
- [16]Gerber JS, Prasad PA, Fiks AG, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial JAMA, 2013.PMID 23757082