The candidate card
Setting
Hospital ward
Candidate
You are a doctor on the medical ward. Mrs Agnieszka Lewandowski is the daughter of a 78-year-old man with metastatic lung cancer, admitted five days ago with increasing pain and breathlessness. The team plans to start regular low-dose oral morphine, with a laxative, for his pain and breathlessness. He is alert and able to make his own decisions. Mrs Lewandowski has asked the nurses not to give him morphine and has asked to speak to a doctor.
Task (interlocutor: relative)
- Find out about Mrs Lewandowski's concerns about morphine (previous experiences, what she has heard)
- Explain why morphine is recommended for her father and correct her misunderstandings (addiction, shortening life)
- Explain the possible side effects and how he will be monitored
- Reassure Mrs Lewandowski about her feelings of guilt and the importance of her father's own wishes
- Agree a plan for discussing the medication together with her father
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
- Ask what she knows or has seen about morphine, including any past experience in the family, before correcting anything. The fear may be tied to a specific memory, and unless you hear it you may answer the wrong worry.
- Explain why morphine is recommended for his pain and breathlessness in plain language, and note the plan is regular low-dose, with a laxative. Address addiction and shortening life directly, saying that when used carefully for symptom relief the aim is comfort.
- Describe the possible side effects honestly and how he will be monitored, so she knows he will be watched. Do not minimise them, as that would damage trust, and do not list every possibility.
- Acknowledge her love and any guilt she may feel, but do not assume it. Gently remind her that her father is alert and can make his own decisions, so his own wishes matter most, and she is not carrying the decision alone.
- Close by agreeing a conversation with her father, ideally with her present if he wishes, in which the team explains the medicine and he decides. Avoid sharing his details beyond what he is comfortable with.
Phrases to adapt
Use your own words; these show the register, not lines to memorise.
- It is clear how much you care about your father. Tell me what worries you about morphine.
- Many people have the same fears, and they are worth talking through.
- The aim is to keep him comfortable, and we will watch him closely.
- Shall we talk with your father together about what he would like?
Medical words in plain English
| Term | How you might say it to the patient |
|---|---|
| metastatic | The cancer has spread beyond where it started. |
| addiction | Craving and misusing a drug. Taking it carefully for pain is different. |
| laxative | A medicine to keep the bowels moving, which morphine can slow. |
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.
More Medicine role-play cards
- Carer strain: reluctance to accept respite Home visit
- New type 2 diabetes: reluctant to start medication General practice
- First febrile convulsion: frightened parent Emergency department, paediatric area
All sets: nurses, doctors, other professions. Your profession's guide: OET Medicine.
Questions about this role-play
Can I give morphine if his daughter objects?
His decision is the one that counts, because he is alert and able to decide. Do not start the medicine without discussing it with him. Explain to her that you respect her concern, but that the choice is her father's.
How do I answer if she asks whether morphine will shorten his life?
Answer directly and calmly. Explain that the purpose is to relieve pain and breathlessness, that it is given carefully and monitored, and that uncontrolled symptoms also take a toll on him. Avoid absolute promises about how long he will live.
What if she becomes tearful or angry?
Pause, acknowledge the emotion, and name it without judging. Find out what is behind it, such as fear of losing him, before returning to facts. Offer time, and suggest involving the palliative care or nursing team if she wants more support.
Sources
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