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Patient Details: Ms Singh

Your Role: Doctor in general medical out-patient clinic

Complaint: palpitations

Referral Text

Dear Doctor,

I would be grateful if you could assess Mrs Singh who presented to me with palpitations. 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:

It is also clear in this station that this patient is a bit of a ‘talker’ who will continue talking about irrelevant information if allowed to. There is an important balance to be struck over allowing the patient to speak freely, but also keep them on track. Otherwise your time will be up and you will know all about their wine tasting, but be none the wiser about their condition.

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 43­-year old woman presents with palpitations, sweating, weight loss and some loose stools. The most likely diagnosis is hyperthyroidism and I would like to confirm this after completing a clinical examination, baseline blood tests and a thyroid stimulating hormone level, with a free T4 level.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]