Explaining a statin — the worried patient
PLAB 2 & PRES 3 · cardiology · medium · 8 minutes
Candidate brief
You are an FY2 doctor in a GP surgery. Mrs Margaret Doyle, 67, had a routine NHS Health Check. Her total cholesterol is 6.8 mmol/L, her blood pressure is 142/86 mmHg, she does not have diabetes, and her calculated 10-year cardiovascular risk (QRISK) is 18%. She has been offered atorvastatin 20 mg daily for primary prevention. She has read worrying things about statins in the newspapers and online. Please discuss starting the statin with her: explain why it has been offered, the benefits and the side effects, and reach a shared decision.
What examiners look for
Start with her headlines, not your agenda. A statin discussion is a negotiation with everything the patient has already read and heard — if you never ask what is on her envelope, you are arguing with an invisible opponent for eight minutes. Natural frequencies are the whole game in prevention counselling. "Cuts your risk by a quarter" sounds huge and means little; "of 100 people like you, about 18 have a heart attack or stroke in ten years — on the tablet, about 13 or 14" is a number a patient can actually decide with. Her friend Eileen is evidence too — one person's real experience. Dismissing anecdotes while quoting trials loses the patient's trust; the skilled move is to honour the story, then widen the frame: aches are common, they are usually reversible, and there is a plan if they happen to her. Answer the diabetes question with both halves. Yes, there is a small association; no, it does not mean the tablet "causes diabetes" in the way the headline implied — put the extra cases and the prevented heart attacks on the same page and let her weigh them. "Once you start, you're on them for life" is the fear underneath most of the others. Naming that the treatment is long-term BECAUSE the risk is long-term — and that she remains in charge of it, review by review — defuses more resistance than any statistic. The "what would you do, doctor?" question is a trust test, not a trap. Share your reasoning transparently, keep the recommendation honest, and hand the decision back: that combination is what shared decision-making actually looks like. A shared decision can legitimately be "not yet". Offering written information, a review appointment and an open door is a successful outcome in this station; steamrolling her into a prescription today is not.
Guideline references
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