🎙️ How to Counsel a Patient on Warfarin | OSCE Talk

In this episode of OSCE Talk, Peter and Matthew walk through how to counsel a patient on Warfarin, focusing on the key differences compared with DOACs such as Apixaban.

We cover when Warfarin is indicated, including mechanical heart valves, rheumatic heart disease, and antiphospholipid syndrome, before breaking down INR monitoring, dose adjustment, and practical safety advice that frequently comes up in OSCEs.

The episode emphasises a structured counselling approach, highlighting bleeding risks, drug and food interactions, pregnancy advice, and when patients should seek urgent medical attention. We also discuss reversal with vitamin K and prothrombin complex concentrate (PCC) and outline how Warfarin counselling fits into the wider anticoagulation framework.

This episode is ideal for OSCE medication counselling stations, foundation doctors, and anyone needing a clear, practical refresher on Warfarin.

• Warfarin is a vitamin K antagonist used for anticoagulation

• Common indications include mechanical heart valves, rheumatic heart disease, AF, VTE, and antiphospholipid syndrome

• Unlike DOACs, Warfarin requires regular INR monitoring

• INR targets vary depending on indication and patient risk

• Doses are adjusted frequently using different tablet strengths

• Patients should carry a Warfarin (yellow) booklet

• Major risks include bleeding, especially GI bleeding and intracranial haemorrhage

• Warfarin interacts with many medications and foods (e.g. antibiotics, NSAIDs, St John’s wort, green leafy vegetables)

• Alcohol and cranberry juice can affect INR

• Warfarin is contraindicated in pregnancy

• Reversal involves vitamin K and PCC in severe bleeding

In this episode of OSCE Talk, we break down how to counsel a patient on Apixaban — a common anticoagulant used for stroke prevention in atrial fibrillation and for the treatment and prevention of DVT and PE.

We cover what Apixaban is, why it’s prescribed, and how to clearly explain benefits, bleeding risks, and safety advice to patients in an OSCE-friendly way.

You’ll learn how to structure anticoagulant counselling, including dosing, missed doses, interactions, red flags, and when patients should seek urgent help.

This episode is ideal for medical students preparing for OSCEs, foundation doctors, and anyone wanting to improve real-world medication counselling skills.

✅ KEY TAKEAWAYS

• Apixaban is a factor Xa inhibitor used for anticoagulation

• Common indications include AF-related stroke prevention, DVT, and PE

• Explain stroke risk vs bleeding risk clearly to patients

• Unlike warfarin, Apixaban does not require routine INR monitoring

• Patients must take it twice daily at the same time each day

• Missed doses should be taken as soon as remembered (same day)

• Major bleeding and head injury require urgent medical attention

• Avoid NSAIDs and inform healthcare professionals before procedures

• Apixaban is contraindicated in pregnancy

• Clear counselling improves adherence and patient safety

In this episode of OSCE Talk, Peter and Matthew break down atrial fibrillation (AF) — one of the most common and clinically important cardiac arrhythmias you’ll encounter in OSCEs and practice.

We explore what AF is, the different types of atrial fibrillation, and why it significantly increases the risk of stroke. The episode then walks through AF management, including rate vs rhythm control, the role of cardioversion, and how to assess stroke risk using the CHA₂DS₂-VASc score.

To bring it all together, we role-play a doctor–patient counselling scenario, demonstrating how to explain AF, anticoagulation, and treatment options clearly, calmly, and safely — exactly what examiners look for.

This episode is ideal for OSCE stations involving cardiology, chronic disease counselling, anticoagulation, or arrhythmia management.

• What atrial fibrillation is and how it affects heart rhythm

• The three types of AF: paroxysmal, persistent, and permanent

• Why AF significantly increases stroke risk

• How and when to use the CHA₂DS₂-VASc score

• Principles of rate control vs rhythm control

• When anticoagulation is indicated

• How to explain anticoagulation risks and benefits to patients

• What cardioversion involves and how to counsel patients about it

• Common patient concerns and how to address them

• How to structure an OSCE-safe AF counselling station

In this episode of OSCE Talk, we break down how to counsel a patient starting an ACE inhibitor, with a specific focus on Ramipril, one of the most commonly prescribed antihypertensives in clinical practice.

We cover when ACE inhibitors are indicated, how to explain their benefits in simple, patient-friendly language, and how to counsel safely on side effects, monitoring, and red flags. The episode also explores NICE guidance, patient selection, and what to do if patients cannot tolerate ACE inhibitors — including when to consider an ARB.

Using a simulated patient interaction, we demonstrate how to structure an OSCE-safe counselling conversation, address common concerns, and ensure patients understand when to temporarily stop their medication.

This episode is ideal for OSCE stations involving hypertension management, medication counselling, or cardiovascular risk reduction.

• What ACE inhibitors are and why Ramipril is commonly prescribed

• How to explain ACE inhibitors clearly without medical jargon

• NICE-based indications for starting Ramipril

• Key contraindications and cautions

• Common side effects (dizziness, dry cough)

• Serious but rare risks (renal impairment, hyperkalaemia, angioedema)

• Why kidney function and potassium must be monitored

• Sick day rules and when to stop the medication

• When to switch to an ARB

• How to structure an OSCE-ready medication counselling station

In this episode of OSCE Talk, we focus on how to counsel patients with hypertension, one of the most common and important conditions you’ll encounter in OSCEs and clinical practice.

We break down what hypertension is, why it’s often called the “silent killer”, and how to communicate risk effectively to patients who may feel completely asymptomatic. The episode covers key risk factors, long-term complications, and how to structure a clear, patient-centred counselling conversation.

You’ll learn how to discuss lifestyle changes, explain when medication is indicated, and help patients understand why managing blood pressure is essential for preventing stroke, heart attack, and cardiovascular disease.

This episode is ideal for OSCE stations involving chronic disease counselling, cardiovascular risk, or lifestyle advice.

• What hypertension is and why it’s often asymptomatic
• How to explain the concept of the “silent killer” clearly to patients
• Diagnostic thresholds and how hypertension is confirmed
• Key modifiable and non-modifiable risk factors
• How to structure a hypertension counselling station
• The role of lifestyle changes (diet, exercise, smoking, alcohol, stress)
• When medication may be needed
• How patient education improves long-term outcomes
• How to encourage engagement without being patronising
• How to keep counselling clear, calm, and OSCE-safe

In this episode of OSCE Talk, we focus on one of the most important — and often underestimated — OSCE skills: patient counselling and communication.

We break down a simple, repeatable structure for counselling patients about new diagnoses and medications, helping you explain conditions clearly, confidently, and without jargon. The episode covers how to assess a patient’s prior knowledge, address concerns, link symptoms to the underlying condition, and check understanding throughout the consultation.

You’ll also learn how to stay flexible during patient interactions, adapt your explanations when patients interrupt or ask unexpected questions, and maintain confidence even when the condition is unfamiliar.

This episode is essential for OSCE stations involving explaining a diagnosis, starting a medication, or discussing management plans.

• A clear structure for patient counselling stations

• How to introduce yourself and set the agenda confidently

• How to assess a patient’s prior knowledge

• Techniques for explaining conditions without medical jargon

• How to address common patient concerns about medications

• The “Normally, we can probably manage” explanation structure

• How to link disease mechanisms back to patient symptoms

• When and how to adapt your explanation mid-consultation

• How to check understanding and encourage questions

• How to remain calm and professional in OSCE scenarios

In this episode of OSCE Talk, we break down how to take a clear, structured dermatology history, with a particular focus on skin lesions and suspected skin cancer.

We walk through a practical approach using the OPERA framework, discuss key skin cancer risk factors, and explain how to assess lesions safely and systematically using the ABCDE framework. The episode also highlights the importance of understanding dermatological terminology, recognising the mental health impact of skin disease, and asking the right background questions in OSCEs and real clinical settings.

This episode is designed to help you sound confident, organised, and clinically safe when faced with dermatology history stations.

• How to structure a dermatology history using OPERA

• Key skin cancer risk factors, including skin type and sun exposure

• Why sunbed use significantly increases melanoma risk

• How to assess skin lesions using the ABCDE framework

• The Three S’s for lesion examination (sight, size, shape)

• Essential dermatology terminology to improve communication

• The relevance of drug history, family history, and steroid use

• How skin conditions can impact mental health and daily life

In this episode of OSCE Talk, we break down how to take a clear, structured ophthalmology history for OSCEs and real clinical practice.

We cover the key eye symptoms you must ask about, how to use a simple framework to avoid missing red flags, and how to recognise ophthalmological emergencies such as sudden vision loss, flashes, floaters, and diplopia.

Using a practical case example, we guide you through differentiating common causes of visual disturbance, including macular degeneration, glaucoma, and retinal pathology — helping you sound confident, systematic, and safe in exams.

Whether you’re revising for OSCEs or starting clinical placements, this episode gives you a repeatable structure you can use in any eye history station.

• A clear framework for ophthalmology history taking

• How to assess visual disturbance effectively

• Key red flags that require urgent referral

• How to localise vision loss (central vs peripheral)

• Common differential diagnoses in eye presentations

• When to escalate to eye casualty

Welcome to Osce Talk 👋

In this episode, we break down Medicine MMI (Multiple Mini Interview) interviews and explain how they really work, based on our own experiences getting into medical school and sitting MMIs ourselves.

We cover:

• What an MMI actually is

• Why MMIs are used instead of traditional interviews

• Common MMI station types (role play, ethics, communication, prioritisation)

• What medical schools are really looking for

• How to approach stations when you’re unsure

• Practical tips to improve your confidence and structure

This series is aimed at students applying to medicine, particularly those preparing for MMIs, but it’s also useful for anyone wanting to improve communication, ethical reasoning, and interview technique.

📌 Future episodes will include:

• Ethics stations explained

• Role-play examples

• Communication stations

• Real MMI practice scenarios

🔔 Subscribe to Osce Talk for practical, exam-focused and interview-focused medical education.

In this episode of OSCE Talk, Matthew and Peter break down how to take a structured collapse history, one of the most important and high-stakes presentations in emergency and general medical practice.

They guide you through the essential Before–During–After framework, helping you differentiate between causes such as seizures, vasovagal episodes, cardiac arrhythmias, and functional collapses.

You’ll learn how to ask the right questions, what contextual clues matter most, and how to safely assess a patient after a collapse — including when driving restrictions and safeguarding concerns are relevant.

This episode is packed with practical, OSCE-ready teaching and real-life clinical reasoning.

• Use the Before–During–After structure to organise your collapse history.

• Open questions help clarify unclear or unwitnessed events.

• Past medical history and medications (e.g., antihypertensives, anticonvulsants) may reveal the cause.

• Social history — alcohol, drugs, stress, sleep — is essential.

• Consider seizure if there is tongue biting, incontinence, or post-ictal confusion.

• Consider cardiac causes (arrhythmia, structural disease) if sudden and unprovoked.

• Vasovagal collapses often have triggers like pain, emotions, or prolonged standing.

• Always ask if they hit their head or suffered injury.

• Patient safety is crucial — including driving advice after episodes of unexplained loss of consciousness.

• Collapse histories are extremely common across emergency, GP, and inpatient care.