How to Counsel a Patient About Myocardial Infarction in an OSCE

Myocardial infarction (MI) counselling is a communication station: you are not diagnosing the patient, you are explaining what has happened, what will happen next, and what they can do to reduce their risk. Geeky Medics publishes an OSCE guide on this exact station, and the approach below follows the standard structure examiners expect — introduce yourself, explain the diagnosis in plain language, cover acute management and secondary prevention, then check understanding and close safely.

Before you start: what the station is testing

You will usually be given a brief such as "Mr X has been diagnosed with an ST-elevation MI and is awaiting primary PCI. Counsel him." The marks are for communication, not cardiology depth. Examiners look for:

• A clear, jargon-free explanation of what an MI is
• An explanation of the immediate plan (e.g. angioplasty/PCI or thrombolysis)
• Secondary prevention advice (medication, lifestyle, cardiac rehab)
• Empathy, chunking, and checking understanding
• A safe closing that invites questions

Step-by-step structure

1. Introduction and consent

• Wash hands, introduce yourself with name and role
• Confirm the patient's name and date of birth
• Gain consent: "Is it okay if we talk about your test results and what happens next?"
• Chunk and check throughout — pause after each section and ask if anything needs clarifying

2. Explain the diagnosis in plain language

Avoid "myocardial infarction" as your opening word. A workable script:

"The tests show you've had a heart attack. This happens when one of the blood vessels supplying the heart muscle becomes blocked by a clot, so part of the muscle isn't getting enough oxygen."

Then check: "Does that make sense so far?" Use the patient's own words back to them if they describe it differently.

3. Explain the immediate plan

• State that the priority is to unblock the artery quickly to limit damage to the heart muscle
• Name the likely procedure (e.g. primary PCI / angioplasty with a stent) and that it is usually done under local anaesthetic with sedation
• Mention that they will be monitored and may be started on medication straight away
• Flag the possibility of transfer to a specialist centre if the local hospital does not provide PCI

4. Cover secondary prevention

This is where many candidates lose marks by rushing. Organise it into medication and lifestyle.

Medication (explain the purpose, not just the name):

Lifestyle:

• Stop smoking — offer referral to cessation services
• Diet: reduce saturated fat and salt, increase fruit and vegetables
• Alcohol within recommended limits
• Exercise as guided by cardiac rehabilitation
• Driving and work: mention that DVLA and occupational rules may apply and that the team will advise

5. Mention cardiac rehabilitation

Explain that a structured programme of exercise, education, and psychological support improves recovery and reduces recurrence. Offer to refer them.

6. Close safely

• Summarise the key points in two or three sentences
• Ask: "What questions do you have for me?"
• Signpost who to contact if symptoms return (e.g. call emergency services for ongoing chest pain)
• Thank the patient and confirm the next step

Common pitfalls

• Jargon dumping — saying "STEMI", "troponin", or "revascularisation" without translating
• Skipping the check-backs — examiners actively score these
• Forgetting the acute plan — candidates often jump straight to lifestyle and miss explaining PCI
• Not addressing fear — acknowledge that this is frightening and that the team is there to help
• Rushing the close — always leave room for questions

How to practise

Run the station aloud with a timer (typically 8–10 minutes), record yourself, and mark against the domains above. Geeky Medics' OSCE guide for MI counselling is a useful checklist to compare your wording against; pair it with their broader communication-skills material if you want to tighten your chunk-and-check technique.