TestAS · Medicine
Health behaviour, doctor-patient communication, ethics, and the numbers behind risk, diagnostic tests and studies.
testas.de lists this topic for the Medicine module. In the test it comes as testlets: a short text, table or formula, then 4 to 8 questions you answer from it.
Topic list: testas.de
Full exam-length testlets from the Kollego course, generated the same way as our mocks. Answer from the material, then open each answer to check.
Breaking bad news and deciding together
Few tasks in medicine are as demanding as telling a patient about a serious diagnosis. How bad news is delivered affects how well patients understand their situation, how much they trust their doctor, how they cope emotionally and even which treatment they choose. Structured approaches have therefore been developed. One of the best known is the SPIKES protocol, which divides the conversation into six steps.
S stands for setting: the conversation takes place in a quiet, private room, without interruptions, with enough time, and, if the patient wishes, with a relative present. P stands for perception: before giving information, the doctor asks what the patient already knows or suspects, for example 'What have you been told so far about the tests?'. I stands for invitation: the doctor finds out how much the patient wants to know, since some patients want every detail and others only the main points. K stands for knowledge: the doctor gives the information in small portions, in plain language, often introduced by a warning shot such as 'I'm afraid the results are not as good as we had hoped'. E stands for emotions: the doctor recognises the patient's reaction, names it and responds with empathy, for example by pausing and saying 'I can see that this is a shock'. S stands for strategy and summary: the next steps are planned together and the main points are summarised.
After bad news, patients typically remember only a small part of what is said, because strong emotions impair attention and memory. Written summaries and a second appointment are therefore helpful.
Deciding on treatment increasingly follows the model of shared decision-making. The doctor contributes knowledge about the options, their benefits and risks, and the evidence. The patient contributes knowledge about their values, preferences and life circumstances. The decision is made together. This model differs from the paternalistic model, in which the doctor decides on behalf of the patient, and from the informative model, in which the doctor lists facts and leaves the choice entirely to the patient. Shared decision-making is especially suitable when several reasonable options exist and the best choice depends on what matters to the patient. Decision aids, such as leaflets that compare options with numbers and pictures, support this process.
| No. | Statement |
|---|---|
| 1 | Before I go through the results, what do you already know about why we did the biopsy? |
| 2 | I can see this is very hard to hear. Take your time. |
| 3 | Would you like me to go through all the details, or shall I focus on what happens next? |
| 4 | There are two options, surgery or radiotherapy. What matters most to you in deciding? |
1. Which SPIKES step does statement 1 represent?
A: Perception
Perception means 'before giving information, the doctor asks what the patient already knows or suspects'. Statement 1 asks what the patient already knows before going through the results, so Perception.
2. Statement 3 corresponds to which step?
B: Invitation
Invitation means 'the doctor finds out how much the patient wants to know, since some patients want every detail and others only the main points'. Statement 3 offers all details or only what happens next, so Invitation.
3. Statement 2 is an example of…
D: an empathic response to emotion
In the Emotions step the doctor 'recognises the patient's reaction, names it and responds with empathy, for example by pausing'. 'This is very hard to hear. Take your time' names the reaction and gives a pause, so it is an empathic response.
4. Which model of decision-making does statement 4 reflect?
C: Shared decision-making
In shared decision-making the doctor brings the options and the patient brings 'values, preferences and life circumstances', and they decide together. Statement 4 names the two options and asks what matters most to the patient, so shared decision-making.
5. Why does the text recommend written summaries after bad news?
C: Strong emotions impair attention and memory
The text says after bad news patients 'remember only a small part of what is said, because strong emotions impair attention and memory'. A written summary lets them read again what they did not take in.
6. In which situation is shared decision-making especially suitable?
C: When several reasonable options depend on the patient's values
The text says shared decision-making 'is especially suitable when several reasonable options exist and the best choice depends on what matters to the patient'. An emergency with one treatment, or an unconscious patient, leaves nothing to decide together.
Health literacy and access to care
Health literacy is the ability to find, understand, evaluate and use health information in order to make decisions about one's health. It includes reading a medicine leaflet, understanding a doctor's explanation, filling in forms, judging whether information on the internet is trustworthy, and knowing where to go for which problem. In a large European survey, almost half of adults showed limited health literacy, with large differences between and within countries. Health literacy is not the same as general reading ability, although the two are related.
Limited health literacy is not evenly distributed. It is more common among older people, people with little formal education, people with low income, and people who have migrated and do not yet speak the local language well. It is therefore one of the pathways through which social inequality becomes health inequality. Studies link limited health literacy with fewer preventive examinations, more errors in taking medication, more visits to emergency departments and more hospital admissions, as well as with higher mortality among older people.
Access to care also depends on factors outside the individual. Geographic access concerns the distance to the nearest practice or hospital, which is a problem in many rural areas. Financial access concerns costs, such as co-payments or services that insurance does not cover. Organisational access concerns opening hours, waiting times and the complexity of the health system. Cultural and linguistic access concerns whether services are offered in a language and a manner that patients understand and trust. Even in countries with universal health insurance, these barriers lead to unequal use of services: people with lower socioeconomic status tend to see general practitioners about as often as others, but use specialists and preventive services less.
Health professionals can reduce the effects of limited health literacy. Recommended techniques include speaking in plain language without jargon, limiting each conversation to a few key messages, using pictures, and checking understanding with the teach-back method, in which the patient explains the instructions in their own words. Professional interpreters, in person, by telephone or by video, should be used instead of relatives, especially children, because relatives may leave out or change information and because patients may not speak openly in front of them.
| Group | Share |
|---|---|
| All adults | 46% |
| Aged 65 and over | 58% |
| Low formal education | 62% |
| University degree | 31% |
1. Which activity is part of health literacy as defined in the text?
A: Judging whether health information online is trustworthy
The text lists what health literacy includes, among them 'judging whether information on the internet is trustworthy'. Paying a premium, living near a hospital or being examined are not about handling health information.
2. By how many percentage points does the share with limited health literacy differ between people with low formal education and university graduates?
D: 31 percentage points
Table: low formal education 62%, university degree 31%. 62 − 31 = 31 percentage points. ('2 times' is a ratio, not percentage points.)
3. Long travel distances to the nearest practice are a barrier of which kind?
C: Geographic access
The text says 'geographic access concerns the distance to the nearest practice or hospital'. Long travel distance is about distance, so geographic access.
4. What is the teach-back method?
D: The patient explains the instructions in their own words
The text describes teach-back as the method 'in which the patient explains the instructions in their own words'. Repeating the explanation or reading the leaflet aloud does not show whether the patient understood.
5. Why should professional interpreters be used rather than the patient's children?
B: Relatives may change information and patients may not speak openly
The text says interpreters should be used instead of relatives, especially children, 'because relatives may leave out or change information and because patients may not speak openly in front of them'.
6. According to the text, how does the use of services differ by socioeconomic status in countries with universal insurance?
B: Specialists and preventive services are used less by the poorer
The text says people with lower socioeconomic status 'see general practitioners about as often as others, but use specialists and preventive services less'. So GP use is similar, specialist and preventive use is lower.
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