[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 Ethelwaite

Your Role: Doctor in general medical out-patient clinic

Complaint: Cardiac valve problem who was lost to follow up

Referral Text

Dear Doctor,

I would be grateful if you could assess Mr Ethelwaite who presented to me with a previous cardiac valve problem who was lost to follow up. 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/149072631″][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 asks if his has happened before, which is a question doctors often forget to ask patients. He might have come out with a diagnosis of epilepsy, which if she had not asked about, would not have been mentioned.

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.

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 Ethelwaite is a 70-year old man with symptomatic aortic stenosis, he reports progressive breathlessness on exertion and chest heaviness in keeping with angina, and a recent episode of collapse with loss of consciousness. There is also a recent history of peripheral oedema which may indicate that he has coexisting heart failure.

I would like to investigate further with a 12-lead electrocardiogram, some venous bloods and a trans-thoracic echocardiogram to assess Mr Ethelwaite’s aortic valve area and the pressure gradient across it.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]