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Table 1 Examples of emotional states an SP can take with sample instructions for the conversation

From: Developing standardized patient-based cases for communication training: lessons learned from training residents to communicate diagnostic uncertainty

Emotional state Case example SP instructions for the conversation Closing comments (only if needed)*
Reassured The patient presented to the ED seeking reassurance about a specific diagnosis and has received it.
The patient is receptive to the conversation. The patient is comfortable going home without a definite diagnosis. The patient asks reaffirming and clarifying questions throughout the scenario.
When/if the physician indicates that no specific diagnosis has been found, the patient responds in a reassured manner.
• Greet provider upon entry.
• Express that you are reassured about how you are physically feeling right now (i.e., you’re your symptoms are better and have not worsened).
Share that you feel reassured with the results so far when they are disclosed to you as normal.
Ask how the physician can explain your symptoms.
When/if the physician indicates that no specific diagnosis has been found, you respond that you are nonetheless reassured.
You can express your reassured state with the following example phrases during appropriate parts of the conversation:
“So it doesn’t look like anything serious? That’s such good news.”
“As long as we aren’t finding anything scary, I’m ok.”
“Thank goodness. I was worried you’d find something terrible.”
“It’s ok, I am reassured by everything you have shared with me today. Thank you for your time and care.”
Confused Throughout the encounter, the patient is confused about the lack of a diagnosis and the inability to find anything specifically wrong. The patient will focus on the lack of a diagnosis.
When/if the physician indicates that no specific diagnosis has been found, the patient responds in a confused manner.
Although the patient is confused, he/she does not display hostile or aggressive behavior.
Greet provider upon entry.
Express eagerness to hear the results.
Inquire with a confused nature, about what the results signify when they are disclosed to you as normal:
“I just don’t understand. How can they be normal?”
Ask how the physician can explain your symptoms.
When/if the physician indicates that no specific diagnosis has been found, you respond in a confused manner.
You can express your confusion with the following phrases during appropriate parts of the conversation:
“I don’t understand how you don’t have an answer.”
“That’s weird, how could everything be normal when I feel this way? Shouldn’t they show something?”
“I wonder why this happened to me.”
“Thank you for trying to help me today. I’m still a bit confused that I don’t have a diagnosis for my symptoms, but I appreciate your time and explanation.”
Inquisitive
Inquiring
The inquisitive/inquiring patient is genuinely interested in understanding what is going on and asks many questions. The patient has researched symptoms online, has spoken to friends, and is invested in his/her care.
The patient is eager to learn about next steps. The patient asks probing questions based on information discloses.
When/if the physician indicates that no specific diagnosis has been found, he/she responds in an inquiring manner.
Questions are not aggressive, nor do they suggest incorrect management. Rather, questions represent curiosity with regards to care.
• Greet provider upon entry.
• Ask inquiring questions regarding your symptoms.
• Inquire with a curious nature about what the results signify when they are disclosed as normal:
• “So, what do normal results mean?”
• Ask how the physician can explain your symptoms. When/if the physician indicates that no specific diagnosis has been found, you respond in an inquiring manner.
• You can express your curiosity with the following phrases during the conversation:
o “I read online that this could be consistent with XXX, could that be the cause?”
o “What else could be going on?”
o “How do you know that I won’t develop worse symptoms?”
“I was hoping to get an answer today, but thank you for explaining things to me.”
“ I am still curious about what is happening, but I’m all set to go home now.”
Nervous
Anxious
The patient is nervous about his/her visit and is anxiously awaiting results. The patient becomes more nervous after not being provided with a diagnosis.
The patient was initially scared to seek evaluation, as a family member was recently diagnosed with cancer. It took a lot of courage for the patient to seek care.
The patient is worried about receiving his/her results, as he/she is terrified about receiving a “bad” diagnosis. No one has yet disclosed any results to the patient, which is making him/her even more nervous.
When/if the physician indicates that no specific diagnosis has been found, the patient responds in a nervous manner. Although the patient is nervous, there is no hostile or aggressive behavior noted.
Greet provider upon entry.
Express nervousness about getting results.
Inquire, with a nervous/anxious nature, about what the results signify when they are disclosed to you as normal:
“Are you sure they are normal?”
“How can you be sure the tests are normal?”
Ask how the physician can explain your symptoms.
When/if the physician indicates that no specific diagnosis has been found, you respond in a nervous/anxious manner.
You can express your nervousness with the following phrases during the conversation:
“Are you sure I’m not dying?”
“How do you know that I won’t develop worse symptoms?”
“What if my symptoms are a sign of something really bad?”
“Thanks for trying to help me today.”
“I’m still quite nervous, but I appreciate your time and explanation.”
  1. *In the event the learner does not adequately respond to the patient’s emotional state that the SP is portraying in column 1, in addition to the SP prompts provided in column 2, the SP can then terminate the conversation using the closing statement(s) provided