Explain Kawasaki disease and its treatment to a frightened parent — OSCE

Candidate instructions

You are the paediatric registrar. You have five minutes to speak with Mrs Patel, whose eighteen-month-old son Arjun was admitted overnight with six days of fever, red eyes, a strawberry tongue and a widespread rash. The team has diagnosed Kawasaki disease and is about to start treatment. Mrs Patel is frightened and has been searching online. Explain what Kawasaki disease is in plain language, what the treatment is and why it is given now, why the heart needs checking, and what the outlook is — honestly and without overpromising. Answer her questions, check her understanding, and agree a plan with her. [1]

Actor brief (parent — Mrs Patel)

You are anxious and tearful, and you have been reading frightening things online about heart damage. You want to know: (1) What is Kawasaki disease, and what caused it — is it an infection, is it your fault? (2) Why are they talking about his heart and doing heart scans — does he have heart damage? (3) What is the treatment, and is it safe — what is this immunoglobulin? (4) Will he be left with a heart problem for life? (5) Could you have brought him in sooner? Push back if the candidate uses jargon, dismisses your worry, or overpromises that everything will be fine. You calm when you feel heard and given honest, clear information. [1]

Exemplar candidate approach

Open and acknowledge. "Mrs Patel, please sit down. I can see how worried you are, and six days of fever with Arjun looking so unwell has been frightening for you. He is in safe hands now, and we know what is wrong. I want to explain clearly what Kawasaki disease is, what we are going to do today, and what it means for his heart, and I will answer every question you have." [1]

Explain the diagnosis in plain language. "Kawasaki disease is an illness where the body's immune system becomes very inflamed for a short time, and it tends to affect the blood vessels, especially the ones that supply the heart. We do not know exactly what triggers it — it is probably a reaction to an infection in a child who is a little more sensitive to it — but it is nothing you did, and it is not your fault. The good news is that it is treatable, and we caught it at a point where treatment works very well." [1] [2]

Explain the heart concern honestly. "The reason we are checking his heart is that the inflammation can sometimes affect the coronary arteries, the small blood vessels that feed the heart muscle. That does not always happen, and the treatment we are giving today is designed to prevent it. We will do a heart scan, an echocardiogram, which is a painless ultrasound of the heart, to look at those arteries now and again in a couple of weeks. Most children who are treated in time have normal heart scans." [1] [3]

Explain the treatment and outlook. "Today we will give Arjun a medicine called immunoglobulin through a drip — it is a purified protein that calms the inflammation down — together with aspirin at a dose that helps prevent clots. We like to give it within ten days of the fever starting, because that is when it works best at protecting the heart. Most children's fever settles within a day or two. I want to be honest: in most children the heart is fine and they recover fully, but in a small number the arteries are affected, and those children need closer follow-up for longer. Either way, we will watch him carefully and explain everything we find." [2] [1]

Address the guilt question. "I understand why you ask whether you should have brought him in sooner. This is not your fault, and you brought him in at exactly the right time for the treatment to work well. Fever for several days is common in small children and usually turns out to be a virus; Kawasaki disease is one of the few where we need to act within a window, and we are well within it." [1]

Check understanding and agree a plan. "Can I check — what is your biggest worry right now, and has anything I have said been unclear? Here is what happens next: Arjun has the immunoglobulin drip today, we do the heart scan today and again in one to two weeks and at four to six weeks, and we keep a close eye on his fever. If the fever does not settle within about 36 to 48 hours we have other medicines we can add. You can stay with him, and you can ask me anything, at any time." [1] [4]

Mark scheme (10 marks)

• Empathy and relationship (2): acknowledges fear and guilt, sits and listens, plain language, does not dismiss or overpromise. [1]
• Explains the diagnosis clearly (2): Kawasaki disease as a short, treatable inflammation of blood vessels, not the parent's fault. [1]
• Explains the heart concern honestly (2): why the coronary arteries matter, the echocardiogram, and that treatment prevents most damage. [1] [3]
• Explains the treatment and outlook without overpromising (2): immunoglobulin and aspirin within ten days, most recover fully, some need closer follow-up. [2] [1]
• Checks understanding and agrees a plan (2): invites questions, checks comprehension, sets out next steps and ongoing availability. [1] [4]