Asleep on the park bench OSCE by Michael

You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.


James Toole is a 43yo man who was brought to your ED last night. He was intoxicated with alcohol, and had evidence of a minor head injury. He had a CT scan of his head which was unremarkable and was observed in your short stay ward overnight. The only other abnormality found was a mildly raised GGT at 160. He is now keen to go home.

Instructions for the candidate

You are the consultant on the short stay unit morning ward round. Please take a history, focusing on alcohol use, and discuss management with the patient.

Domains being examined

  • Medical Expertise
  • Health Advocacy
  • Professionalism
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

You are a 43yo electrician. You do not recall all of the events of last night. You were out with mates at the pub, had a few beers (>8), then woke this morning in hospital. You do not recall having a CT scan. You now have a mild headache and feel a little shaky.

You drink most days after work (5-6 beers with mates) and often more on weekends (6-10 Friday / Saturday). Sunday night is normally a night off (only 1-2 beers). You have once or twice thought about cutting back, but this drinking pattern/amount is about average amongst your friends. You have not felt angry, guilty, nor use eye-openers. You sometimes get a bit shaky when you haven't had a drink for a couple of days. You occasionally miss work due to a big night out. You have never had any police issues. You have once before come to hospital with a scalp laceration sustained after a fall while intoxicated. You are married with 2 children (aged 12 and 8). Your wife has suggested you drink too much. Your mood has been good with no depressive symptoms.

You do not see your drinking as a significant problem, but would be quite concerned about liver damage as an incentive to reduce.

You can simulate a shake/anxiety if you so wish.

For the examiner


Domains Assessment Objectives

Medical Expertise
Assessment and counselling of alcohol abuse

Health Advocacy
Alcohol reduction advice

Maintain non-judgemental approach

Other Assessment Notes

1. General history
- PHx, meds, allergies
- smoking, illicit drugs
- occupation
- driving

2. Alcohol use
- quantity / frequency / drinks per session
- CAGE / AUDIT tools
- prior EtOH related injury, illness
- forensic consequences
- memory loss
- withdrawal symptoms
- depressive symptoms
- impact on life / work / relationships ("unable to do what was expected")

3. Counselling
- potential for harm
-- short term - injury, occupation, relationship, forensic
-- long-term - liver disease, brain, pancreatitis
- reduce complications
-- thiamine, multivitamins
-- withdrawal management

4. Referral for services
- drug /alcohol services
- GP

- explore presenting story and identify risks involved (head injury without memory, could be worse, etc)

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