The candidate card
Setting
Community clinic
Candidate
You are a doctor in a community clinic. Ms Ngozi Musa, aged 28, is a hospital nurse who has had migraine since her teens. For the past few months she has had headaches on most days. She takes codeine-containing painkillers and ibuprofen on 18 to 20 days a month. Her neurological examination today is normal. She has come in asking for a stronger painkiller.
Task (interlocutor: patient)
- Find out about her headache pattern and how she uses her painkillers (types, amounts, how long, effect, symptoms when she misses a dose)
- Explain medication-overuse headache and why a stronger painkiller is not the answer
- Reassure her about her worries about stopping the painkillers (what to expect, support available)
- Explain other ways to manage her headaches (headache diary, preventive treatment, possible triggers)
- Agree a plan for stopping the ibuprofen and gradually reducing the codeine, 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
- Take a careful history first, including exactly which tablets she takes, how often and for how long, what they achieve and what happens when she misses one. Her answers give you the evidence to use when you explain the problem.
- As a nurse she will understand medicines, so avoid talking down to her, but do not assume she knows this condition. Explain that frequent painkiller use can itself keep headaches going, so a stronger painkiller would not solve it.
- Find out what she most fears about stopping, and ask rather than assume. Be honest that headaches may be difficult during the change, while describing the support available. Do not give a timescale the card does not provide.
- Present the diary, preventive treatment and trigger review as what you will do with her, not instead of her pain. Clarify the order: stopping the ibuprofen first, then gradually reducing the codeine, not stopping codeine abruptly.
- If time is short, secure the explanation, her agreement to the stop-then-reduce plan and a follow-up date. Check how drowsiness from codeine might affect driving or work, and finish by asking her to summarise the plan.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- I can see how much these headaches are affecting you. Let us work out what is behind them.
- This is not about doubting your pain. The tablets may now be keeping the headaches going.
- What worries you most about cutting down?
- You will not be doing this alone, and we will review how it is going.
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| medication-overuse headache | Headaches that continue or worsen because painkillers are being taken on too many days. |
| preventive treatment | A daily medicine taken to reduce how often migraines and headaches come, not to treat one attack. |
| headache diary | A simple record of headache days, triggers and tablets taken, so we can see patterns. |
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
How do I refuse a stronger painkiller without damaging rapport?
Acknowledge that she is in pain and came for relief. Explain that your reason is that more or stronger tablets would likely keep the problem going, and then move quickly to what you can offer, so the consultation ends with a plan, not a refusal.
Should I mention her being a nurse?
Use it lightly to build respect, for example by acknowledging that she knows about medicines, but do not assume she is immune to this problem. Explore any shift work pressures or fear of being seen as dependent, without implying either applies.
Why stop the ibuprofen first and reduce the codeine slowly?
The card sets this order: the ibuprofen is stopped, and the codeine is gradually reduced. Explain the reason as making the change manageable and safer for her, and ask what she would find difficult about it, so the plan is realistic.
Sources
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