[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]Patient Details: Mr O’Connell

Your Role: Doctor in general medical out-patient clinic

Complaint: Chest infections

Referral Text

Dear Doctor,

I would be grateful if you could assess Mr O’Connell who has had several chest infections that we cannot seem to clear with multiple antbiotics. Please arrange  investigations.

Your role is to take a thorough history from the patient and, based on the information you obtain, construct a differential diagnosis and investigative plan for investigation.
You should also then explain these to the patient and answer any questions or concerns they may have.
Do not examine the patient and ensure you return all papers to the  examiner at the end of the exam.

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/151694447″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/6″][stat_counter icon_size=”32″ counter_title=”Time to prepare before station begins” counter_value=”5″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/6″][stat_counter icon_size=”32″ counter_title=”Time for this station” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/6″][stat_counter icon_size=”32″ counter_title=”Time to talk to your patient” counter_value=”14″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/6″][stat_counter icon_size=”32″ counter_title=”Pause for reflection” counter_value=”1″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/6″][stat_counter icon_size=”32″ counter_title=”Time for discussion and questions with examiners” counter_value=”5″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/6″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Discussion”][vc_column_text]The first key feature is that the doctor introduces herself and checks the patient’s name. She allows the patient to give their information without interrupting. She allows him to speak. Often doctors, through bad habits, because we work out the diagnosis often very quickly in our heads, it is tempting to just go straight for the questions that confirm the presumed diagnosis. However, not only will you miss other features of a history that may indicate an alternative, it does not allow the patient to convey all that they want to and they may not give all the best information.

Remember to start with open questions before going into closed questions, as time goes on:

The doctor asks what the patient’s concerns are, as this may be different to yours. In this station, the diagnosis is clear, but you need to exclude red flag symptoms of, for example, lung cancer. You can be concerned about this in your head, but if the patient does not mention it, and you are, as the doctor, through questioning, not concerned, do not mention it.

The doctor makes sure she takes a full systems review before moving past the history of presenting complaint. Also, as she forgets something, she does say ‘sorry, I forgot to ask…’. This is allowed.

She also says a useful question ‘are there any other symptoms I have not asked about’.

Notice how she asks the same questions about the systems, just to make sure. If you cannot remember the answers given, you can check again. Also she checks she has gotten the correct information by checking back with the patient.

Asking patients about illicit drugs can be tricky and some people may be offended. Note how the doctor signposts it by normalising it ‘I have to ask everyone’ rather than appearing to think someone looks like they take illegal drugs (this also works for unprotected intercourse).[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Presentation”][vc_column_text]In summary, Mr O’Connell is a 47-year old man with a 30-pack year history who presents with worsening symptoms of breathlessness, wheeze and a reduced exercise tolerance, likely due to chronic obstructive pulmonary disease. There are no common trigger factors and his symptoms are not being controlled with Step 2 therapy as in a short acting beta agonist and preventative therapy with an inhaled steroid.

I would like to carry out an examination of Mr O’Connell, check his cardiovascular and respiratory observations, peak flow, a 12-lead electrocardiogram, as well a plain chest radiograph and spirometry.[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]