Counselling a family toward high-value care — OSCE

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]

Tasks for the candidate

1. Acknowledge and explore the parent's concern, their belief that antibiotics prevent complications, and what they hope the treatment will achieve. [9]
2. Explain in plain language why an antibiotic is low-value for a viral illness, naming the harms of resistance, adverse effects and downstream demand. [16] [5]
3. Share the decision and agree a safety-net, including clear return precautions and the option of a delayed prescription where appropriate. [13] [9]
4. Frame restraint as good care for their child and confirm understanding with teach-back. [8]

Expected performance

Must hit. Concern acknowledged and explored rather than dismissed; plain-language explanation that antibiotics do not help viral illness and carry harms of resistance, adverse effects and future demand; safety-net with explicit return precautions; shared decision confirmed by teach-back; restraint framed as protecting the child, not as cost-cutting. [9] [13]

Merit. Names the parent's underlying need (reassurance and certainty) and meets it without the antibiotic; offers a delayed or backup prescription; checks health literacy and the online source respectfully; documents the decision and the safety-net for the next clinician. [16] [8]

Fail. Prescribes the antibiotic purely to end the encounter; dismisses the parent's concern or the online information; gives no safety-net; frames non-prescribing as policy or cost; fails to confirm understanding. [5] [13]

Sample candidate structure

"Thank you for bringing her in — I can see you are worried, and I want to make sure we do the right thing for her. Can you tell me what you read online and what you are hoping the antibiotic would do? … Her illness is almost certainly viral, and the good news is that antibiotics don't help viral infections and can actually cause harm — they can cause side effects, they make future infections harder to treat, and they often lead families back for more. … I am not refusing to treat her; I am choosing the treatment most likely to help and least likely to harm. Here is what we will do instead, and exactly when to come back. …" [16] [9]