Simulated Patient Instructions - Pennine GP Training
Patient Instructions
Name of Patient: Matt Smith 50 years
Description of the patient & instructions to simulator:
Matt Smith, works as a VW camper restorer
Self employed, has to be working to be earning
Married
2 children at university
Saw GP 1 month ago with a swollen hot red rt forefoot, told it was gout, given an information leaflet and some Naproxen tablets twice a day for a week to see if it helped.
Non smoker
Little alcohol
You had a blood test last week at the request of the GP
You forgot to mention to the GP that you had have suffered from early morning stiffness for last 4 months and that it takes at least an hour to get going, you have been getting up early to allow for this. It has been difficult doing fine motor tasks first thing in the morning.
3 weeks ago the knuckles of your right hand were red and inflamed and sore but you had attributed it to working in the cold under a campervan but it has just settled with ibuprofen which caused a bit of indigestion but it did the job.
Ideas – getting results of the ‘gout blood test’
Concerns – The short course of Naproxen and Lansoparazole has helped his foot but not the early morning stiffness and it is now starting to cause a problem with work, as he needs to keep turning over the VW campers quickly to make money
Expectations – blood test results and something better than Naproxen
Doctor’s (GP ST) Instructions
Name & age of patient Matt Smith 50
Summary Card
PMH: Gout and DU
DH:None
Allergies:None
BP/BMI/ ?smoking and alcohol hx: BP 120.70, non smoker, little alcohol
Case Notes - Last few entries in records:
Classic looking gout rt foot.
1st attack. Drinks little alcohol
Naproxen 500mg BD for 10 days with lansoprazole 30mg a day
See PN in 3 weeks for bloods and rev with results
PILealfet provided
eGFR 70
Uric Acid 2.0 (normal)
Hba1c normal
FBC normal
Rh Factor raised at 40
CSA EXAMINATION CARD
Patient Name: John Smith
Examination findings: Squeeze test of hands +ve, no mcp inflammation and no deformity of hand and foot normal
CSA Case Marking Sheet
|Case Name: Matt Smith |Case Title:Rh A |
|Context of case | |
|New diagnosis and symptom control of Rheumatoid arthritis | |
|Assessment Domain: | |
|1. Data-gathering, technical and assessment skills | |
|Positive descriptors: |Negative descriptors: |
|ICE explored |SPICE not explored |
|Impact explored |Lack of focussed hx around inflammatory arthritis |
|Blood test interpreted appropriately |Inappropriate or inadequate examination |
|Enquiry re prior other joint involvement and early morning stiffness | |
|Assessment Domain: | |
|2. Clinical Management Skills | |
|Positive descriptors: |Negative descriptors: |
|Explanation of results |Results not explained |
|Explanation of possible Rh A |Incomprehensible explanation |
|Offer of depomedrone, analgesia, more nsaids with PPI cover etc |No further investigation |
|Further bloods – anti CCP and CRP |No referral |
|Referral to rheumatologist |No symptomatic Rx |
|Safteynetting |Poor safety netting |
|Assessment Domain: | |
|3. Interpersonal skills | |
|Positive descriptors: |Negative descriptors: |
|ICE & impact identified and addressed |SPICE not used |
|Comprehensible explanation of possible Rh A |No shared decision making |
| | |
| | |
|Other aspects e.g. time keeping, consultation structure, comment on | |
|consultation skills etc | |
|Positive descriptors: |Negative descriptors: |
| | |
|Grading: Clear pass = 3, Marginal Pass = 2, Marginal Fail = 1, Clear Fail = 0 | |
|Data Gathering Score = |Clinical Management Score = |
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