Explain a symptom score and negotiate a treatment change — CASC communication station

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in a community clinic. [3]

Candidate instructions. Build rapport. Explain why questionnaires are used (to track change and guide decisions). Interpret PHQ-9 16 and GAD-7 11 in plain language without claiming a laboratory diagnosis. Check suicidal thoughts even if item 9 is 0 today. Explore side effects, adherence, and goals. Propose a collaborative plan (e.g. dose optimisation within product guidance, adherence support, psychotherapy access, earlier review) and agree when to remeasure. Avoid jargon, cut-off worship, and invented legal section numbers. [1][2][3]

Candidate scenario

Your patient is 41, English-speaking, employed part-time. They started sertraline 50 mg six weeks ago after a depressive episode with prominent worry. They completed today’s questionnaires reluctantly. PHQ-9 total 16 (moderately severe band on Kroenke anchors) with item 9 = 0; GAD-7 = 11 (above common screen cut-point of 10). They say numbers feel cold. If asked about suicide they deny current plan/intent but describe passive thoughts last month. Adherence is mostly good; sexual side effects are bothersome. They want to feel better for work. [1][2]

Marking domains

• Empathy and destigmatising explanation of MBC [3][5]
• Accurate plain-language score interpretation (severity bands ≠ diagnosis) [1][2]
• Suicide risk exploration beyond the form [1]
• Shared decision: treat-to-target using measurement logic [3][4]
• Adherence and side-effect enquiry
• Concrete remeasure plan and safety-net
• Professional close without checklist robotic tone

Common station failures

Reading cut-offs as diagnoses; skipping suicide questions because item 9 is 0; arguing with the patient about “needing forms”; no treatment change despite non-response; no remeasure plan; overloading with trial acronyms without plain language. [1][3]