Step 2 CS Counseling

Asthma follow up:
"Mr. Smith asthma is a chronic disease that needs long term therapy. Most common cause of recurrence of asthma symptoms is interruption of controller medications. The inhaled medication (name it if the patient told you the name) is a steroid that suppresses swelling of your airways and prevents symptoms. You should take it every day without missing a single dose. I am happy to see that you are regular with your follow up checkups and I would like to see you again in about 3 months for a checkup. Do you have any questions regarding the treatment plan Mr. Smith?"

Alcohol addiction:
Most patients in the CS exam will either be occasional drinkers or chronic alcoholics. So it wont be so confusing as to who to counsel. But when you are confused go ahead and counsel. Some people counsel if a man has more than 3 drinks a day and if a woman has more than 2. If you feel unsafe you can say "Mr. Smith you are doing a great job by restricting your alcohol intake to____ drinks a day. However ... ..." and then say the following paragraph. If he is a clear cut alcoholic just counsel him as follows.
"As a concerned physician, Mr. Smith, I must inform you about the ill-effects of alcohol consumption. Besides altering judgment, excess consumption raises your risk of liver disease, heart disease and stroke. (In case of a woman of childbearing age also talk about ill effects on fetus.) If you ever decide to quit Mr Smith we have a team of professionals who would be eager to help you overcome your habit.


"Mr Smith I know dealing with depression can be extremely difficult. Depression causes immense physical and emotional stress. But we can beat it. We have a number of techniques and medications that help with depression. I advise that you make an appointment with our counselor at the earliest. Mr Smith I am also going to write you a prescription for an antidepressant. We need to do some lab work including a blood cell count and electrolyte levels prior to that. Also Mr Smith you should remember that antidepressants can take up to 4-6 weeks to show effect. So you have to be patient. If you ever feel like hurting yourself or others you must at once seek medical attention or at the least talk to a friend."

"Mr. Smith drugs are not the only things that will help control your blood sugars. Regular exercise and modified diet will play a big role in managing your diabetes. In addition diabetes makes you more prone to infection, especially infection of your feet. You must use footwear with soft soles and avoid wearing tight shoes. This maintains adequate blood flow to your feet and prevents infection. "

"Mrs. Smith, bed wetting is extremely common at this age. Studies show that with each advancing year about 10% of kids with bed wetting will outgrow their symptoms. A number of behavioral modifications can help decrease bed wetting. These include not drinking liquids in the last couple hours prior to going to bed, waking the child up in the middle of the night to urinate, avoiding tea/coffee or caffeine containing soda with dinner and ensuring that 'Tommy' goes to the bathroom just before going to bed. If these modifications don't work we may consider bed wetting alarms or even medications in the future. Do you have any other questions that I can answer Mrs. Smith?"

"Mr. Smith drugs are not the only things that will help control your high blood pressure. Regular exercise and modified diet will play a big role in managing your hypertension. Hypertension also puts you at high risk for heart disease and stroke. You must at once contact a doctor if you experience chest pain, weakness of any limbs, sudden severe headache or have visual problems."

Smoking cessation:
"Mr. Smith, in the end I would like to inform you about ill effects of smoking. Smoking increases the risk for chronic lung disease, heart disease and lung cancer. I understand that it is very difficult to let go old habits but our trained professionals can help. They have a number of ways to minimize the urge to smoke and reduce the withdrawal symptoms. Please feel free to contact us if you ever decide to quit."

Trichomonas positive:
"Ms. Smith the test we had sent to check for infection has returned positive for trichomonas. Trichomonas is a parasitic infection that is easy to treat by oral medications and I shall write you a prescription for the same. The medication is called Metronidazole and is an antibiotic. It has mild adverse reactions that you should be aware of. It can cause metallic taste in the mouth that will go away when you stop this medication. Also you should avoid alcohol while on this medication as you may develop flushing and headache. In addition you should abstain from sex until therapy is complete. In addition Ms Smith your sexual partner needs to take the same medication in order to prevent further transmission. Do you have any questions about the treatment Ms Smith?"

Domestic violence:
You should not get very personal but at the same time demonstrate empathy and show that you are ready to help. You can say something like:
"From what you said I understand that at times you feel unsafe at your own home. That sounds very frustrating Mrs Smith. I am glad that you came to seek attention. If you ever need someone to talk with do not hesitate to call our office. If ever you feel unsafe or are hurt you should seek attention from the police or appropriate authorities. And if you do not feel comfortable doing that you can always come to us for help and if you wish we could arrange for someone to go to the police with you. Does it sound reasonable to you?"

Febrile Seizure:
"Mrs. Smith, the description you provided makes me think Tommy has febrile seizures. It is a common and benign condition in children. While some of them may have a recurrence with fever most of them will not have a second episode. Almost all children will out grow the seizures by age of 5 or 6 years. Most of these seizures stop in 5-6 minutes and if Tommy has another episode lasting longer than that you must take him to the Emergency Room. Some doctors would recommend seizure medications for frequent febrile seizures but at this point I don't fell Tommy needs it. Do you have any questions about the plan Mrs. Smith?"

Safe Sex Counseling:
You should ask the following 5 questions about sex to all patients. Before asking these you should ask for permission saying "Mr. Smith I now need to ask you certain personal questions in order to arrive at a more accurate diagnosis. Is that ok with you?" (You should ask for Addictions and Sexual history once you have asked for permission to ask personal questions.)

1) Are you sexually active?
2) With men, women or both?
3) How many active partners do you have?
4) Have you had other partners in the past?
5) Do you use condoms? (In women you can in addition ask "What other form of contraception do you use?")
Based on the answers of above you should determine if the patient is at high risk of STDs.
If the patient is at high risk you can tell them "Mr. Smith as your concerned physician I should warn you that your sexual habits put you at a high risk of acquiring sexually transmitted diseases including Hepatitis, HIV and Gonorrhea. It is safest to have one constant partner and use condom everytime you have sex. Oral and anal sex also increases the chances of infection and a condom should be used at all times. If you wish we can test you for such infections. Also Mr Smith, don't be afraid to talk about safe sex with your partner. Your partner is probably just as concerned about risks as you. Talking about safe sex is an expression of caring for your partner and yourself."


  1. Can you please post counseling for the following cases: domestic violence, chronic backache, headache, hemoptysis. thanks.

  2. Also about Neonatal jaundice counselling.

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  4. I think you have covered all the
    problems which have to face to every human being.

    Smith Alan

  5. This comment has been removed by a blog administrator.


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