[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 Smith

Your Role: Doctor in general medical out-patient clinic

Complaint: Jaundice

Referral Text

Dear Doctor,

I would be grateful if you could assess Mr Smith who presented to me with jaundice. 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/149207628″][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:

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. The systems review will alter slightly depending upon where you think the diagnosis is going.

She also summarises what she has been told to make sure she has the correct information and has not missed anything, a useful method to make sure you have not missed anything.

The medication history is clarified, the patient says occasional, but it is important to know how many.

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]”Mr Smith is a 47-year old gentleman with a history of painless jaundice, with associated malaise, weight loss and a past history of heavy alcohol use. The most likely diagnosis is of a pancreatic head cancer. I would like to complete my assessment by carrying out a complete examination, carry out baseline blood investigations, a urinalysis, arrange an urgent ultrasound of the abdomen, which if positive, I will then arrange a CT of the chest, abdomen and pelvis to help with staging.

I will refer Mr Smith for the upper-GI multidisciplinary meeting to decide, depending upon investigations, the best method of biopsy and then treatment.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]