Simulated Patient Instructions
Patient Instructions
Name of Patient: Helen Carter age 55
Description of the patient & instructions to simulator:
You are 55 and for the last 3 months have had sore eyes, particularly towards the end of the day, which can sometimes go pink but not red. Sometimes your eyes run (tears). You have had no eye problems in the past and have had no change in your vision. You last went to the optician 5 months ago and everything was ok.
You are a typist in the local Engineering company.
Only if asked: You spend 8 hours a day in front of a computer and have little or no breaks. You wear disposable contact lenses for work. Your eyes feel dry and gritty at times and is a real nuisance at work by the end of the day.
You have no other health problems or eye symptoms.
Lives with her two cats Lizzy and Parsley
Medication: Elleste Duet (combined HRT) and low dose Amitriptyline 10mg at night to help you sleep ever since your husband died 3 years ago (cancer). You have come to terms with the loss of John and take Amitriptyline more out of habit.
Ideas - ? a grumbling infection ? conjunctivitis
Concerns – its uncomfortable
Expectations – Some antibiotic eye drops
Opening line – “Doctor I’ve come for some antibiotic eye drops”
You would be happy to try eye drops and eye ointment. You would be able to try going back to glasses rather than continued contact lens wear. You would be happy to try without Amitriptyline but not keen on stopping HRT.
Doctor’s (GP ST) Instructions
Name & age of patient Helen Carter age 55
Summary Card
PMH: HRT started 2 years ago
DH: Elleste Duet and Amitriptyline 10mg ncote
Allergies: Non
Case Notes - Last few entries in records:
10 months ago: Regular periods on combined hrt, no BTB, no PCB, no Discharge, up to date with smears, mammo last year normal, no SE and pleased with control of flushes. BP and BMI normal, no VTE hx so Rx issued for 1 year.
CSA EXAMINATION CARD
Patient Name: Helen Carter
Examination findings: VAs 6/6, lids normal, no fluorescein uptake, corneas bright, AC normal, pupils ractive.
If requested – Tear Break Up Time Test = 6 seconds or Schirmer’s tests 6mm of wetting after 5 mins
CSA Case Marking Sheet
|Case Name: |Case Title: |
|Context of case | |
|Dry eye syndrome | |
|Assessment Domain: | |
|1. Data-gathering, technical and assessment skills | |
|Positive descriptors: |Negative descriptors: |
|ICE explored |SPICE not explored |
|Impact at work identified |CL wear or prolonger computer screen use not identified |
|Current medication identified |Inadequate examination |
|Contact lens use identified | |
|Prolonged computer screen use identified | |
|Appropriate examination | |
|Assessment Domain: | |
|2. Clinical Management Skills | |
|Positive descriptors: |Negative descriptors: |
|Comprehensible explanation of dry eye syndrome |No comprehensible explanation |
|Advice regards taking breaks from the computer screen, considering a |No practical non eye drop based options |
|trial of reverting to glasses rather than contact lens wear and |No medical options other than eye drops |
|possible benefits of Omega 3 rich diet |No shared decision making |
|Explanation that TCAs and HRT may make it worse |No safety netting |
|Explanation of eye drop/ointment use | |
|Shared management plan | |
|Safety netting | |
|Assessment Domain: | |
|3. Interpersonal skills | |
|Positive descriptors: |Negative descriptors: |
|ICE explored and used |SPICE not explored |
|Empathy regards death of husband or problems caused at work |No empathy |
|Rapport established and maintained |Little rapport |
|Shared decision making |No shared decision making |
| | |
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