🩺 Tuberculosis Treatment Counselling

High-Yield OSCE Points 🧠

📚 Knowledge

TB is a serious bacterial disease primarily affecting the lungs but can spread to other organs.
Treatment is essential to prevent complications and disease spread.
Standard treatment lasts ~6 months using 4 drugs: rifampicin, isoniazid, pyrazinamide, ethambutol.
Initial 2 months: all four drugs; subsequent 4 months: rifampicin and isoniazid only.
Public health notification is required; close contacts may need screening.
Common side effects include orange bodily fluids (rifampicin), neuropathy (isoniazid), joint pain and liver toxicity (pyrazinamide), vision problems (ethambutol).
Monitoring includes liver function tests and vision assessments.
Patients are infectious for approximately 2 weeks after starting treatment; self-isolation is advised.
Adherence to medication is critical to prevent drug resistance and treatment failure.

✅ Strategy & Summary

Ensure patient understands treatment duration and drug regimen.
Explain side effects and importance of monitoring.
Highlight infection control measures including isolation and contact precautions.
Encourage adherence and clarify infectious period.

Full Word-for-Word OSCE Script 📜

❓ What TB is and why it should be treated

Doctor: "Tuberculosis is a serious bacterial disease, primarily affecting the lungs but potentially spreading to other parts of the body like the kidneys, nerves, stomach, and heart if left untreated."

"It’s very important to treat TB to prevent these complications and to stop the infection spreading to others."

"Because of your penicillin allergy, we avoid penicillin-based antibiotics and use alternative medications."

🕒 General information on TB treatment

Doctor: "Treatment usually lasts about six months and involves taking four different antibiotics: rifampicin, isoniazid, pyrazinamide, and ethambutol."

"For the first two months, you take all four medications. After that, you continue with just rifampicin and isoniazid for the remaining four months."

"I am required to notify public health authorities, who may contact your close contacts for screening."

⚠️ Adverse drug reactions (ADRs)

Doctor: "These medications can have side effects which you should be aware of."

"Rifampicin can cause your sweat, urine, and tears to turn orange — this is harmless but can be surprising."

"Isoniazid may cause nerve-related symptoms, so we also give vitamin B6 to reduce this risk."

"Pyrazinamide can cause joint pains, including gout, and liver toxicity."

"Ethambutol can affect your vision, so we will test your eyesight before and during treatment."

"If you experience any concerning side effects, please contact us immediately. I can also provide detailed written information for you."

🩺 Monitoring

Doctor: "We will monitor your liver function through blood tests, and regularly check your vision to detect any early problems."

🦠 Infection control and compliance

Doctor: "You will remain infectious for about two weeks after starting treatment."

"During this time, it’s important to avoid contact with vulnerable people such as children, elderly, and immunocompromised individuals."

"Self-isolation is advised to prevent spread."

"Adhering to your treatment regimen is crucial, even if you start feeling better early, to avoid developing drug-resistant TB."

❤️ Exploration & Empathy

Doctor: "How do you feel about the information I have provided?"

🗣️ Strategy and Summary

Doctor: "Could you please summarise the treatment plan we've discussed to ensure I've explained everything clearly?"