It is very important to identify and counsel recreational/illicit drug use in simulated patients during USMLE Step 2 CS exam.
Ask all SPs about recreational drug use in the personal/lifestyle history section of Past Medical History (PMH).
Ask about the type of substance, its route, frequency and duration of use
Use appropriate transition sentences before asking about recreational drug use. Refer to Smoking Cessation Counseling section for details.
After asking about smoking and alcohol use, ask the patient:
Have you ever used any recreational drugs?
if the patient says yes, ask about the type of drug, route and duration
Which Drug?
Pause and wait for response
For how long?
Pause and wait for response
How did you take it?
Pause and see response
Have you tried any other drug?
Most SPs will tell nearly all the details on first one or two questions, but you need to get all the details.
Tip: You can note down the details, to write them accurately later during patient note writing.
Suppose the patient is not a smoker or alcohol user, you can counsel as follows
Make an eye contact and say
Mr XYZ being a concerned physician i must tell you that use of recreational drug (name of the drug) in not good for for your helath, if can cause a lots of helath problem like (depends on the particular drug)*.
Pause to see the response for just a moment, then continue
I would like you to quit using it as soon as possible. Are you willing to quit?
Pause to see the response, appreciate if positive
If you need any help just let me know, I am here to assist you.
* You should remember the main health porblem cause by common recreational drugs, like
Cocaine, Heroine, Marihuana, etc
Tip: For Recreational Drug use you have to
1) ask a screening question
2) note the amount and duration and type
3) show your concern
4) tell him aobut the health hazards
5) advise to quit.
6) check his willingness to quit
7) encourage and appreciate if it is positive
8) offer help and assistance
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