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Case ID: 1
Created: 8 Dec 2008

Station 4:You are the registrar in charge of the medical unit.

Subject: Dr Lee, 22 years old

Dr Lee is your new house officer and he works under your supervision. Your ward sister just informed you that she found out that Dr Lee always leave the ward without any obvious reasons. She recently received a complaint from a nurse that Dr Lee was uncontactable even though he was on-call. Your ward sister also believe that Dr Lee might be abusing alcohol and drugs.You are asked by your sister to talk to Dr Lee or else she will make a formal complaint to the Hospital Director.You are asked to talk Dr Lee.

You have 14min until the patient leaves the room, followed by 1min for reflection before the discussion with the examiners.


     It is quite common to find problematic house officers nowadays. You might be given a similar scenario during your MRCP PACES and I group this type of cases as 'confrontation scenario'.You are supposed to talk to abusive, angry or unsatisfied patients, co-workers or even patients' relatives. A few general rules apply in this type of scenario,

1) Never say that you are asked by someone to confront them, such in this case, always tell Dr Lee that you find out lately his work performance is not up to par and you would like to find out the reason.

2) Always tell them you are there to help and not to blame them. Tell Dr Lee that as a medical personel, team work is important and you understand that the first few months of housemanship is always very hard for new comers and you are there to help him and share his problems.

3) Never threaten your subject and try to reach a consensus what both of you want to do next.

4) Always inform your subject that you share his/her feeling. You have gone thorugh housemanship yourself and you know that during this period, houseman always look for guidance and support.

Common questions examiners would ask you

arrow1) What is your plan of action if Dr Lee's work performance does not improve after a few months?

arrow2) How do you respond if your ward sister insists that she does not want Dr Lee to be on call in her ward again?

arrow3) When will you refer Dr Lee to hospital discipline committee?

Extra points:

1) Learn more about alcoholism at


Created: 8 Dec 2008

Interesting Images in Clinical Medicine.



Case History:

    Mr Teoh is a 55-year old Chinese gentleman with hypertension and chronic smoking. He came to hospital complaining of severe abdominal pain. Please describe the CT abdomen above. What is the abnormality and what is the probable diagnosis??

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