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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