Communication 7: Explanation / Managing a chronic medical condition

Theme: Poor management of a chronic medical condition
Suitable for: Paediatric trainee (ST1-5); GP trainee
Clinical scenario: 14yo Ellie has T1DM on multiple daily injections.  At her last clinic appointment it was noticed that her BMs and HbA1c were higher than expected.
Information for candidate: Please explore the reasons behind Ellie’s poor diabetic control.
Information for actor: Your parents separated 6 months ago.  You live with your mum but see your dad regularly, including staying over at weekends.  You are angry with your parents for separating.

You don’t like being ‘different’ from your friends and hate using insulin around them.  You have recently started seeing a boy at school and don’t want him to know about your diabetes.

You know that using less insulin can result in losing weight so you are deliberately using too little.  You have lost some weight and are happy about this.  You know this is dangerous  but don’t fully understand the severity of DKA.  You think you can manage to avoid getting really ill but still use the minimum insulin possible.

You aren’t feeling particularly well at the moment.

Information for scenario lead: Clarify that the candidate understands the multiple daily injections management of diabetes and the consequences of not adequately controlling diabetes.

Terminate the scenario when the candidate has fully explained the importance of managing diabetes and ‘Ellie’ has accepted this.

Possible points for discussion in debrief: Clinical discussion –  consequences of poor managemet of diabetes.

Exploring reasons behind poor compliance.

Ways to support a teenager in improving their management of their condition.

Psychosocial effects of a chronic health problem.

Scenario contributed by Claire Strauss

The clinical details of this simulation scenario are not based on any one particular case. Similarity to any real life clinical scenario or child is purely coincidental.