[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: Ms Shae

Your Role: Doctor in general medical out-patient clinic

Complaint: Non specific symptoms

Referral Text

Dear Doctor,

I would be grateful if you could assess Ms Shae who presented to me feeling generally unwell. 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.

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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.

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]”This is a 42­ year old woman with symptoms consistent with hypercalcaemia likely due to primary hyperparathyroidism. I would like to carry out an examination. I would like to confirm the diagnosis by repeating baseline bloods, checking the parathyroid hormone and arranging an ultrasound of the neck and if confirmed, refer to an ENT surgeon for further assessment of the management options.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]