Explaining an endoscopy referral — the anxious patient

PLAB 2 & PRES 3 · gastroenterology · medium · 8 minutes

Candidate brief

You are an FY2 doctor in a GP surgery. Mr Brian Kelleher, 59, has had indigestion and heartburn for four months that have not settled despite a course of omeprazole, and he has lost about 3 kg without trying. His full blood count and other blood tests are normal. You are referring him for an urgent direct-access upper gastrointestinal endoscopy (gastroscopy) under the suspected-cancer pathway. Please explain the referral and the test, and address his concerns.

What examiners look for

An urgent suspected-cancer referral conversation has two patients in it: the disease fear and the procedure fear. Candidates who spend eight minutes on gastroscopy technique facts while the man is silently convinced he is dying have answered the wrong question. Honesty about cancer is a technique, not a personality trait. The formula that works: name why the referral is urgent, state plainly that most people referred this way do not have cancer, list what else the test commonly finds, and admit the limit — "I can't tell you either way until we look." Anything vaguer reads as concealment to an anxious patient. Percentages calm people down when words cannot. "Most people referred on this pathway don't have cancer" lands differently from "try not to worry" — one is information, the other is an instruction to feel differently, and patients only obey the first. Explain the test as a story with a beginning, middle and end: preparation (fasting, tablets, the letter), the day itself (arrival, spray or sedation choice, mouth guard, ten minutes, breathing normally throughout, biopsies painless), and afterwards (results on the day, biopsy results later, who contacts whom). Anxiety feeds on gaps; a complete story leaves fewer gaps. The brother's hosepipe is the real clinical problem in this station. Explore the specific fear, correct the specific misconception (you breathe around the tube; it does not choke you), and offer the specific control (throat spray, sedation, a stop signal). Generic reassurance fixes none of it. Sedation is not general anaesthesia — say so explicitly, because half the room believes it is. Knowing he will be drowsy but breathing for himself, and that someone must drive him home, are the two facts that change his planning. Do not forget the modifiable clues sitting in the history: weekly ibuprofen and forty years of smoking. They belong in the plan — framed as things he can act on now, which also returns a sense of control to a man who feels processed by a pathway. Safety netting is the close of every "wait for the urgent test" consultation: name the specific red-flag symptoms, say exactly what to do if they happen, and give him a route back that is not the appointment letter.

Guideline references

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