The candidate card
Setting
General practice
Candidate
You are a GP. Mr Shane Mercer, aged 45, a self-employed tiler, injured his lower back lifting boxes of tiles 10 days ago. On examination there are no red-flag features: no leg weakness, numbness, bladder or bowel symptoms, fever, weight loss or history of cancer. You have diagnosed non-specific acute low back pain. He is frustrated and has asked for an MRI scan and 'something stronger' than the ibuprofen he has been taking irregularly.
Task (interlocutor: patient)
- Acknowledge Mr Mercer's frustration and find out how the pain is affecting him
- Explain your findings and why a scan is not needed at this stage (no warning signs; scans often show changes unrelated to pain and do not change treatment)
- Explain why strong opioid painkillers are not recommended (little benefit, side effects, risk of dependence)
- Advise on a management plan (stay active, a short course of anti-inflammatory medication if suitable, heat, physiotherapy, modified duties)
- Explain warning signs that need urgent review and arrange follow-up
In the test you get 3 minutes to read the card and plan, then about 5 minutes to talk. This card is original, written for this site; the interlocutor's card is not shown.
How to approach this card
- Lead with his frustration. The demand for a scan may reflect worry that something serious is being missed, so ask what he hoped a scan would show and what the pain stops him doing. Naming this first lowers resistance later.
- Explain your examination findings before any refusal. Telling him which serious problems you looked for and did not find turns no scan into a reassuring result, not a rejection. Never imply nothing is wrong, because his pain is real.
- Handle the opioid refusal separately from the scan and offer something in its place straight away. He has taken ibuprofen irregularly, so ask how he used it before suggesting a short anti-inflammatory course, and check it is suitable for him.
- Link the plan to his work. As he is self-employed, he may be worried about lost income, so discuss what modified duties could look like in practice. Keep the message that staying active helps, and avoid wording that sounds like rest or just cope.
- Safety-net using all of the red-flag features you screened for, said together in one list, with what to do if any appear. Fix a review time before he leaves. Typical error: a vague come back if it gets worse.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- I can see how frustrating this has been, especially with your work depending on your back.
- Tell me what you were hoping a scan would show us.
- Let me explain what I checked for, and what that tells us.
- Could we work out together what you can still do safely at work?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| non-specific low back pain | Lower back pain where no serious cause has been found. |
| MRI | A detailed scan of the inside of your back using magnets. |
| opioids | Strong, morphine-type painkillers that can cause side effects and dependence. |
How this card is marked
Two assessors mark the recording on nine criteria: intelligibility, fluency, appropriateness of language and resources of grammar and expression (each 0–6), then relationship building, understanding and incorporating the patient's perspective, providing structure, information gathering and information giving (each 0–3). Grade B usually means 5 on each language criterion and 2 on each clinical one. See the AI Speaking practice guide for what each criterion looks for.
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All sets: nurses, doctors, other professions. Your profession's guide: OET Medicine.
Questions about this role-play
He says a mate had an MRI and it found the problem. How do I respond?
Do not dismiss his friend's experience. Explain that scans often show changes that are unrelated to the pain and do not change treatment, so a finding does not always explain symptoms. Then bring him back to what you did find on examination and the plan.
How firm should I be about refusing opioids?
Be clear and unapologetic, giving the card's reasons: little benefit, side effects and risk of dependence. Then move straight to what you will do for his pain. Refusal followed by silence is what makes patients feel dismissed.
What if he says he cannot take time off work?
Take it as a practical problem to solve. Ask which tasks aggravate the pain and discuss modified duties that keep him active. The card asks for modified duties, not rest, so avoid framing it as being signed off.
Sources
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