Discussed Scenario – Father refusing consent for Lumbar Puncture. 10 month old admitted with fever and convulsion, likely diagnosis of meningitis.Good candidate play and I did the role play of the father.A number of learning points.

• You do NOT need a diagram to explain every situation.
• Some things can be dealt with with a simple brief explaination – “CSF for test”.
• Reduce pain by local anaesthetic, sucrose in neonates
• You do NOT need a pain team to decide on pain relief.
• Discuss treatment options and durations – may help decision making
• When discussing a diagnosis: DONOT say ‘I think diagnosis is ..” – say “I suspect or highly likely to have”.
• Is he going to die? – Be reassuring – “No or Unlikely with adequate treatment’. Do NOT skip.
• “Do you know what is the matter with …”  – ‘What have you been told so far’?
• Try to move from a specific test to the relevance in relation to treatment.
• Meningitis need to be treated – hence LP is necessary to decide on correct treatment.
• ‘Hot seat’ is important to learn.

I will add this to www.mrcpchonline.org visit to add more that I may have missed.
Anil Garg