Clinical Setting
Neurology Outpatient Clinic
Communication Station
Breaking Bad News Parkinson's Disease with Recurrent Falls
Learn an examiner-focused approach to explaining a new diagnosis of Parkinson's disease to a patient's daughter, addressing recurrent falls, responding to emotions, and developing a shared management plan.
At a Glance
A quick overview of the station, highlighting the communication context, clinical setting and the core skills expected by the examiner.
Station Type
Breaking Bad News
Participants
Doctor and Patient's Daughter
Patient
70-year-old gentleman with recurrent falls and newly diagnosed Parkinson's disease.
Time
10 Minutes
Difficulty
★★★★☆ Intermediate–Advanced
Communication Framework
A structured consultation approach that ensures empathy, organisation and examiner-friendly communication throughout the station.
Introduction
Build rapport, introduce yourself and obtain permission to discuss the patient's condition.
Explore Understanding
Assess the relative's current understanding, concerns and expectations.
Warning Shot
Prepare the relative before revealing the diagnosis.
Deliver the Diagnosis
Explain the diagnosis clearly using simple, compassionate language.
Respond to Emotion
Pause, acknowledge emotions and provide empathetic support.
Explain the Condition
Explain Parkinson's disease, the cause of the falls and likely future implications.
Management Plan
Discuss treatment, multidisciplinary care and safety-netting.
Summarise & Close
Invite questions, summarise key points and arrange follow-up.
Clinical Scenario
A 70-year-old gentleman has been referred to the Neurology Clinic because of recurrent falls over the past six months. Following assessment, he has been diagnosed with Parkinson's disease.
His daughter has accompanied him throughout his investigations and has been given permission by her father to discuss his condition with the medical team.
She would like to understand the diagnosis, why her father has been falling, what treatment is available and what the future may hold.
Candidate Task
You are the SHO working in the Neurology Department.
Please speak with the patient's daughter.
- Explain the diagnosis.
- Explain why her father has been experiencing recurrent falls.
- Discuss the management plan.
- Address her concerns and answer her questions.
You are NOT required to examine the patient.
Why This Station Is Challenging
This is not simply a station about explaining Parkinson's disease. It is primarily a test of your communication skills, organisation, empathy and ability to support a relative receiving unexpected news.
Candidates commonly lose marks because they concentrate on medical knowledge instead of responding to the person's emotions and concerns.
The examiner expects you to balance several skills simultaneously:
- Deliver unexpected news with empathy.
- Recognise and respond to emotional cues.
- Explain Parkinson's disease using simple language.
- Avoid unnecessary medical jargon.
- Discuss uncertainty honestly without removing hope.
- Develop a shared management plan.
- Check understanding throughout the consultation.
What the Examiner Is Looking For
Build Rapport
Introduce yourself, create a supportive atmosphere and obtain permission to discuss the patient's condition.
Explore Understanding
Identify the relative's current understanding, concerns and expectations before giving information.
Deliver the Diagnosis Clearly
Give a warning shot, state the diagnosis clearly and allow time for the information to be absorbed.
Demonstrate Empathy
Recognise emotions, allow silence and respond with empathy before continuing the discussion.
Explain Simply
Use everyday language that relatives can easily understand, avoiding unnecessary medical terminology.
Shared Planning
Discuss treatment, multidisciplinary care, follow-up and safety-netting while checking understanding throughout.
Key Communication Principles
These are the communication principles that distinguish a high-scoring PACES candidate from an average one. Master these before working through the consultation.
Build Rapport First
EssentialWhy it Matters
The first minute determines the tone of the consultation. A calm introduction builds trust and helps the relative feel comfortable discussing difficult news.
Say This
"Hello, I'm Dr Ahmed, one of the neurology doctors looking after your father."
Avoid This
"Your father's results are back. Let's discuss them."
Examiner Pearl
Rapport is demonstrated through warmth, eye contact, introductions and permission—not by rushing into information.
Explore Understanding First
EssentialWhy it Matters
Understanding what the relative already knows prevents unnecessary explanations and helps tailor your discussion.
Say This
"Before I explain today's results, could you tell me what you already understand about your father's condition?"
Avoid This
Launching straight into the diagnosis without assessing existing understanding.
Examiner Pearl
High-scoring candidates adapt their explanation to the relative's level of understanding rather than delivering a rehearsed speech.
Give a Warning Shot
High YieldWhy it Matters
A warning shot prepares the relative emotionally before hearing unexpected news, making the diagnosis easier to process.
Say This
"I'm afraid the results aren't quite what we were hoping for."
Avoid This
"Your father has Parkinson's disease."
Examiner Pearl
A brief pause after the warning shot often scores better than continuing immediately.
Respond to Emotion Before Information
CriticalWhy it Matters
Relatives rarely remember explanations given immediately after distressing news. They first need their emotions to be acknowledged.
Say This
"I can see this is a lot to take in. Please take your time."
Avoid This
Continuing into a long explanation without recognising the relative's reaction.
Examiner Pearl
Empathy is demonstrated by recognising emotions and allowing silence—not simply by saying "I'm sorry."
Check Understanding Throughout
EssentialWhy it Matters
Breaking information into small sections and checking understanding prevents information overload.
Say This
"Does that make sense so far?"
Avoid This
Delivering a long uninterrupted explanation without pausing.
Examiner Pearl
Good communication is a conversation, not a lecture.
Stage-by-Stage Consultation
Follow this structured consultation to deliver difficult news with confidence while demonstrating the communication skills expected in the MRCP PACES examination.
Introduction & Building Rapport
Objective
Introduce yourself, establish rapport, confirm that the patient has given permission to discuss his condition and create a supportive environment before delivering any information.
Suggested Phrases
"Hello, I'm Dr Ahmed, one of the doctors working with the neurology team."
"I understand you've come today to discuss your father's test results."
"I understand your father has given permission for us to discuss his condition together."
Avoid
- Starting immediately with the diagnosis.
- Ignoring introductions.
- Assuming permission has been given.
Examiner Thinking
The examiner is assessing professionalism, rapport and respect for confidentiality before any medical discussion begins.
Explore Understanding & Expectations
Objective
Establish what the daughter already knows, identify her concerns and tailor the consultation to her level of understanding.
Suggested Questions
"Before I explain today's results, could you tell me what you've understood so far?"
"What have the doctors already told you?"
"What were you hoping today's appointment would clarify?"
"Is there anything in particular that's worrying you today?"
Avoid
- Assuming the relative knows nothing.
- Giving a rehearsed explanation.
- Ignoring the relative's concerns.
Examiner Thinking
High-scoring candidates discover the relative's agenda before deciding what information needs to be provided.
Prepare the Relative (Warning Shot)
Objective
Prepare the relative emotionally before delivering the diagnosis.
Example Dialogue
"I'm afraid the results aren't quite what we were hoping for."
"Unfortunately, the investigations have shown a condition affecting your father's brain."
Avoid
- Giving the diagnosis without preparation.
- Talking continuously after the warning shot.
Examiner Thinking
A brief pause after the warning shot allows the relative to prepare emotionally before hearing the diagnosis.
Deliver the Diagnosis Clearly
Objective
State the diagnosis clearly, compassionately and without unnecessary jargon.
Example Dialogue
"I'm very sorry to tell you that your father has been diagnosed with Parkinson's disease."
Avoid
- Using vague language.
- Launching immediately into a detailed medical explanation.
- Trying to soften the diagnosis so much that it becomes unclear.
Examiner Thinking
State the diagnosis once, clearly and confidently, then allow silence before continuing.
Respond to Emotions
Objective
Recognise the relative's emotional response before giving further information.
Example Dialogue
"I can see this is difficult news to hear."
"Please take your time."
"I appreciate this is a lot to take in."
"I'm here to answer any questions you may have."
Avoid
- Ignoring tears or silence.
- Changing the subject.
- Giving excessive reassurance.
- Continuing with a long lecture.
Examiner Thinking
Empathy is demonstrated by recognising emotions, allowing silence and responding supportively before moving on.
Explain the Diagnosis
Objective
Explain Parkinson's disease in clear, simple language and relate it to the patient's symptoms without overwhelming the relative with unnecessary detail.
Key Points to Cover
- Parkinson's disease is a progressive neurological condition.
- It develops because brain cells producing dopamine gradually become damaged.
- Dopamine helps control smooth, coordinated movement.
- This explains symptoms such as slowness, stiffness, tremor and poor balance.
- The recurrent falls are likely related to impaired balance and movement.
- Symptoms usually develop gradually and vary between individuals.
Example Dialogue
"Parkinson's disease is a condition that affects the brain's ability to control movement."
"It develops gradually because the brain produces less of a chemical called dopamine, which helps movements remain smooth and coordinated."
"This explains why your father has been experiencing slowing of movement, problems with balance and the falls you've noticed."
Examiner Thinking
Use everyday language. Explain the diagnosis in a way a family member could easily repeat to someone else.
Discuss Management & Support
Objective
Explain that effective treatments and supportive services are available while maintaining realistic expectations.
Key Points to Cover
- There is currently no cure, but symptoms can often be managed effectively.
- Medication can improve movement and quality of life.
- Physiotherapy helps improve mobility and reduce falls.
- Occupational therapy supports independence and home safety.
- Speech and language therapy may help if speech or swallowing problems develop.
- Regular follow-up allows treatment to be adjusted as symptoms change.
Example Dialogue
"Although we can't cure Parkinson's disease, we have several treatments that can help control the symptoms."
"We'll work with a specialist multidisciplinary team to help your father remain as independent and active as possible."
"We'll continue to review him regularly because treatment can be adjusted over time as his needs change."
Examiner Thinking
Offer realistic hope. Reassure the relative that support continues beyond today's consultation.
Summarise, Safety-Net & Close
Objective
Summarise the discussion, check understanding, answer questions and agree on the next steps before closing the consultation.
Key Points to Cover
- Summarise the diagnosis and management plan.
- Invite questions.
- Check the relative's understanding.
- Provide written information where appropriate.
- Arrange follow-up with the Parkinson's team.
- Explain when to seek medical advice if new concerns arise.
Example Dialogue
"To summarise, your father has Parkinson's disease, which explains his movement difficulties and falls."
"We'll start treatment, arrange support from our specialist team and continue to review him regularly."
"What questions do you have, or is there anything you'd like me to explain again?"
Examiner Thinking
Strong candidates never finish by asking only, "Any questions?" They summarise first, then invite questions and confirm understanding.
Handling Challenging Responses
Relatives rarely follow a perfect script. The examiner wants to see how you respond to difficult questions with empathy, honesty and professionalism.
"Is Parkinson's disease curable?"
High-Scoring Response
"At the moment we don't have a cure for Parkinson's disease. However, we have very effective treatments that can improve symptoms and help people maintain their independence for many years."
Why This Works
Honest, realistic and hopeful without giving false reassurance.
"Will he end up in a wheelchair?"
High-Scoring Response
"Everyone's Parkinson's disease progresses differently, so it's difficult to predict exactly what will happen. Our aim is to provide treatment and rehabilitation that help him remain as mobile and independent as possible."
Why This Works
Acknowledges uncertainty while focusing on ongoing care and realistic goals.
"Did we miss this earlier?"
High-Scoring Response
"Please don't blame yourself. Parkinson's disease usually develops gradually, and the early symptoms can be very subtle. Nothing you've told me suggests that you caused this."
Why This Works
Addresses guilt directly while remaining factual and supportive.
"How long will he live?"
High-Scoring Response
"I understand why you're asking that question. Unfortunately, it's not possible to predict exactly how long any individual will live. Many people live for many years with Parkinson's disease, and our focus is on helping your father maintain the best possible quality of life."
Why This Works
Recognises the concern, avoids false certainty and redirects the discussion towards achievable goals.
Relative becomes tearful and remains silent.
High-Scoring Response
"I can see this is incredibly difficult news. Please take your time. I'm happy to sit with you for a moment."
"(Allow silence before continuing.)"
Why This Works
Recognises emotion, allows silence and demonstrates empathy without trying to fill every pause.
Exam Day Checklist
Introduce yourself and confirm permission to discuss the patient's condition.
Explore the relative's understanding before giving information.
Give a warning shot before delivering the diagnosis.
Pause and respond to emotions before explaining further.
Explain Parkinson's disease using simple, non-technical language.
Discuss treatment, multidisciplinary support and follow-up.
Summarise the discussion, check understanding and invite questions.
Rapid Revision
Review these key points immediately before your PACES examination.
Opening
Introduce yourself, confirm permission to discuss the patient's condition and establish rapport.
Before the Diagnosis
Explore the relative's understanding and give a warning shot.
Delivering the Diagnosis
State the diagnosis clearly, pause and allow time for the information to be absorbed.
Responding to Emotion
Acknowledge emotions, allow silence and avoid rushing into explanations.
Explaining Parkinson's Disease
Use simple language, relate the diagnosis to the patient's symptoms and avoid unnecessary jargon.
Management
Discuss medication, multidisciplinary care, follow-up and realistic expectations.
Closing the Consultation
Summarise, check understanding, answer questions and agree on the next steps.
Examiner's Golden Rule
Communication is a conversation—not a lecture. Listen, pause, acknowledge emotions and tailor information to the relative's needs.
Further Reading & References
- Royal College of Physicians. MRCP(UK) PACES Candidate Guidance.
- National Institute for Health and Care Excellence (NICE). Parkinson's Disease in Adults.
- NICE Guideline NG71. Parkinson's Disease in Adults.
- General Medical Council. Good Medical Practice.
- General Medical Council. Decision Making and Consent.
- SPIKES Protocol for Delivering Bad News.