Simulated Patient Instructions - Pennine GP Training
Patient Instructions
Name of Patient:
Kevin
Description of the patient & instructions to simulator:
After the shock of discovering you had prostate cancer, the biopsy, the scan, radiotherapy and biclutamide you are pleased that at the urology clinic your PSA is < 0.3 BUT the sweats are a nuisance (you can live with them) and the almost complete erectile dysfunction is starting to erode your self esteem (although your wife is not too bothered!). The urology registrar suggested seeing your GP for Viagra.
In fact, you tried some from a friend and it had little effect!! The dose you tried was Viagra 50mg which you took soon after a large but romantic Valentine’s Day evening meal - only disclose dose and how you took it if asked).
You still drink very little alcohol and are a non-smoker
You have no morning erections, poor libido, struggle to maintain an erection with masturbation or with sex. No urinary symptoms, no incontinence.
You want to know what other options you can explore.
Ideas - Pleased the prostate cancer treatment seems to have worked but saddened by the side effect of ED which you think is likely to be permanent
Concerns - ED is permanent and there is no treatment
Expectations - Anything that might help!
Doctor’s (GP ST) Instructions
Name & age of patient
Kevin
Age 58
Summary Card
PMH:
DH:
Allergies:
BP/BMI/ ?smoking and alcohol hx:
Case Notes - Last few entries in records:
Last entry in records
Seen by nurse for flu vac
In good spirits, coping ok with prostate cancer Rx
Flu vac left deltoid
CSA EXAMINATION CARD
Patient Name: Kevin
Examination findings:
n/a
CSA Case Marking Sheet
|Case Name: Kevin part 3 |Case Title: Erectile dysfunction/Prostate cancer |
|Context of case | |
|Erectile dysfunction since treatment for prostate cancer | |
|Assessment Domain: | |
|1. Data-gathering, technical and assessment skills | |
|Positive descriptors: |Negative descriptors: |
|Thorough history of erectile dysfunction |No further history taken |
|Psychosocial history – wife’s opinion, other stress, alcohol use etc |No psychosocial hx |
|Identifies what he has already tried and the dose and how he used it |No ICE exploration |
|Elicits ICE | |
|Assessment Domain: | |
|2. Clinical Management Skills | |
|Positive descriptors: |Negative descriptors: |
|Provides an explanation for his ED |Does not explain how to optimise Viagra effectiveness |
|Explains the doses of Viagra and how best to take it to optimise its |Unaware of options available |
|chances of working |Gives private prescription |
|Is able to explain treatment options beyond Viagra – including Cialis, |Does not offer treatment |
|MUSE, Vacuum devices and Cavaject etc |Limited suite of options discussed |
|Defines follow up for review and possible change of treatment/see with |ED clinic referral not offered as a potential future option |
|wife | |
|Explains re free prescriptions for these items | |
|Offers referral to the ED clinic | |
|Assessment Domain: | |
|3. Interpersonal skills | |
|Positive descriptors: |Negative descriptors: |
|Consults in a sensitive manner |Lacks empathy |
|Empathetic |Dismisses/minimises symptoms as a minor problem or something that all |
|Is able to talk about erections and sex rather than euphemisms which |men get when their prostate cancer is treated |
|often break rapport by maintaining embarrassment |Does not recognise sensitive issue |
|Uses ICE in the management part of the consultation |Seems rushed and flustered |
|Maintains rapport |Rapport lost |
|Engenders hope |Limited options fail to engender hope |
|Shared decision making |No shared decision making |
| | |
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