Medical school simulation colonoscopy counselling What to tell a patient before their colonoscopy appointment. Can be used to prepare for OSCEs and DOCCEs. Medical school/PLAB/USMLE.

1. Colonoscopy
Counselling

2. Colonoscopy Counselling
• ‘If you have any questions at any point, or if something is not clear, please feel free to interrupt and ask me.”
• Ideas
• “What do you already know about having a colonoscopy?”
• Concerns
• “Is there anything worrying you about having a colonoscopy?”
• Expectations
• “What were you hoping we would cover today relating to having a colonoscopy?”
• “Is there anything you particularly wanted to focus on or discuss today?”
• “What are you hoping to get out of this consultation?”

3. • Just so we are on the same page, could you tell me a bit about why you need a colonoscopy?”
Explaining the procedure:
• “A colonoscopy is a test to look inside your colon/large bowel. A long, thin, flexible tube with a
camera on the end (colonoscope) is passed into your bottom/back passage. We will be able to have a
clear view of the bowel and may take some samples called biopsies.”
• Colonoscopy is used to look inside your bowels when you have symptoms like blood in the poo, a
change in bowel habit, or unexpected weight loss. It is also used as a screening test for bowel polyps
and bowel cancer. Screening is testing for a disease when you have no symptoms, aiming to catch the
disease early before symptoms appear.”

4. • “Polyps are little growths of cells in the bowel. The majority are not serious and will never
cause you any problems. When polyps are found, they are removed by the endoscopist to be
looked at in more detail as there is a chance they could grow and later cause problems.”
• The main alternative to colonoscopy is a CT virtual colonoscopy. This is less invasive and
doesn’t involve sedation. This uses x-rays and computers to create a detailed model of your
large bowel however, it doesn’t allow a direct look at the lining of your bowel or samples
(biopsies) to be taken.

5. • Your bowel needs to be empty for the colonoscopy so we can have a clear view, otherwise the
bowel may not be clear, and we might have to repeat the test. In the days before, you will be
given a diet sheet of foods you can and can’t eat. Make sure you are drinking lots of
fluids. You must take a strong laxative the day before to clear your bowel. It will cause
diarrhoea, so you will need to stay close to a bathroom. On the day of the colonoscopy, you
won’t be able to eat but you can have clear fluids up until two hours before.”

6. • When you arrive, a nurse will explain the procedure and its possible risks. You will need
to sign a consent form to say you understand and agree to the procedure. You will be asked
to change into a hospital gown and then have your vital signs taken, like your blood
pressure, and heart rate. A cannula will be inserted, usually into the back of your hand.
A cannula is a little plastic tube to give sedation and other medicines. You will be offered
sedation to make you relaxed, and this will make the procedure more comfortable.”

7. • For the colonoscopy, you will be taken to a room with an endoscopist and two nurses. You will be
asked to lie on your left side and bring your knees up to your chest. Before the doctor can insert the
scope, they will need to do a finger examination of your back passage.
• The endoscopist will insert the scope through the back passage and into the bowel. Air is then
passed through to inflate the bowel, this gives a better view of the bowel lining. The doctor may ask
you to change your position during the procedure. This helps the movement of the scope and
improves their view of your bowel. It will also help make you more comfortable, so they may need
you to shift around a bit. The colonoscope will go through the whole large bowel relaying pictures to
a monitor. During the procedure, the doctor will remove any growths (polyps) or take a sample of
cells (biopsy); this doesn’t hurt.”

8. • After the procedure, you will be taken to the recovery room and nurses will monitor you
until you’re ready to go home. Ensure you have arranged for someone to pick you up as you
can’t drive after the procedure. Have a responsible adult with you for 24 hours after the
procedure and don’t drive. After the colonoscopy, a nurse or doctor will review the results
with you before leaving. However, it may take two to three weeks to receive the results of
any samples (biopsies) taken during the procedure.”

9. • During and after the procedure, you may experience some abdominal pain and cramping.”
• “As we inflate your bowel with air it is normal to experience cramping, bloating, discomfort and
flatulence. It is normal to have a small amount of blood in the poo or from the bottom in the days
following the procedure.”
• “In rare cases, colonoscopy can harm the bowel. The colonoscope can cause a hole in the bowel
(perforation), and some patients may experience heavy bleeding. You must seek urgent medical
advice if you experience heavy bleeding, severe abdominal pain or develop a fever after a
colonoscopy.”
• “While colonoscopy is a safe and effective test, it is not 100% perfect. There is a small chance that
during the procedure, a cancer or polyp may be missed.”

10. • Close the consultation by summarising what you have discussed. This allows
you to emphasise the key points of the consultation.
• Finally, thank the patient for their time and offer them
a leaflet summarising the key information.
• Dispose of PPE appropriately and wash your hands.

11. References
• https://geekymedics.com/explaining-a-colonoscopy-osce-guide/