[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 Balding

Your Role: Doctor in general medical out-patient clinic

Complaint: Known type 2 diabetes and suffering from complications

Referral Text

Dear Doctor,

I would be grateful if you could assess Mr Balding who presented to me with multiple complications from his type 2 diabetes. 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/149207627″][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. The doctor also asks the ‘get out of jail free’ question “is there anything else I have not asked’ – if you have missed something, then this is method to get some of that information.

The doctor makes sure she takes a full systems review before moving past the history of presenting complaint. when she asks about his diabetic control, the patient says it is good. However, she does not let this be the final answer, and it turns out his levels, when he checks is around 11-12 which is poor control and in keeping with his underlying diagnosis. However, this method does not work with smoking, it often does not. Patients generally know smoking is wrong and harmful and try to minimise how much they smoke.

She also signposts about what she is going to ask, for example ‘just some specific questions’ so the quick, short, sharp questions do not make the patient uncomfortable.

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=”Specimen case presentation”][vc_column_text]”In summary, Mr Balding is a type 2 diabetic with secondary complications of diabetic neuropathy in both his legs and a stroke. He is controlled in insulin, but has likely background retinopathy. I would like to fully examine the patient, with particular attention to the infected toe ulcer.

I would like to check his cardiovascular observations. For the foot, I would like to take a swab of the pus for microbiological analysis. I would also like to arrange an X-ray of the foot to check for osteomyelitis as he is now in pain, which may indicate the infection has deepened. I would also like to take baseline bloods and carry out a 12-lead electrocardiogram.

I believe he may need an urgent surgical review, as if there is a deep tissue infection, it may need surgical debridement. I would commence antibiotics today for the infected toe ulcer.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]