Simulated Patient Instructions - Pennine GP Training
Patient Instructions
Name of Patient:
Kelly Smith
Description of the patient & instructions to simulator:
Kelly Smith is a 28 year old lady who works as a Hairdresser. She left school at 15 and doesn’t like coming to the GPs. She does not have any children but would like to in the next few years.
She has just started a new relationship. She would like to discuss contraception – she is currently using the withdrawal method. Her friend takes the combined oral contraceptive pill so she has wondered about that.
She is not particularly keen on the coil as she does not like the idea of the thing being side her. She does not like the idea of having to use the mini-pill, her friend got pregnant using it!
Would not be keen on depot due to its association with a possible slow return in fertility.
She might like the idea of an implant – no tablets!
She will choose the Nexplanon implant if is explained fully but will ask the doctor what she should do whilst waiting for this. If the Nexplanon implant is not suggested elect for the mini pill.
She has periods every 28 days, they are not particularly heavy, no intermenstrual bleeding and no post coital bleeding. She has no vaginal discharge and no pain when having sex.
She is currently on her period – Day 4. She had a normal smear 2 months ago.
She has no significant family history.
She works regular shifts, she lives with a friend. She is a non smoker and drinks within the recommended limits.
She was diagnosed with epilepsy 10 years ago. She takes Lamotrigine as an antiepileptic. She has no side effects and remembers them religiously. She is known to a neurologist. She has been fit free for the last 2 years. She was thrilled to get her driving licence back 12 months ago.
Doctor’s (GP ST) Instructions
Name & age of patient Kelly Smith, Aged 28
Summary Card
PMH: Epilepsy
DH: Lamotrigine
Allergies:NKDA
BP/BMI/ ?smoking and alcohol hx: BP 110/70 BMI 23.2 Non smoker Alcohol 13 units/week
Case Notes - Last few entries in records:
3/6/15
Annual epilepsy review. Stable on Lamotrigine. No fits for 18 months. Continue current plan.
12/12/2014
Sore throat. Likely viral. Advice given
CSA EXAMINATION CARD
Patient Name: Kelly Smith
Examination findings: BP 112/77 BMI 23.2
CSA Case Marking Sheet
|Case Name: Kelly Smith |Case Title: Epilepsy and Contraception |
|Context of case | |
|Contraception in GP surgery | |
|Assessment Domain: | |
|1. Data-gathering, technical and assessment skills | |
|Positive descriptors: |Negative descriptors: |
|ICE explored regards contraception |ICE not explored |
|Driving license holder established |Doesn’t ask about plans for family |
|Asks about epilepsy history and last fit, compliance, SE etc |Does not ask about driving |
|Asks about previous contraception |No questioning re possibility of pregnancy/LMP/STI |
|Ask appropriate gynae/sexual history |Does not exclude possibility or pregnancy by hx |
|Assessment Domain: | |
|2. Clinical Management Skills | |
|Positive descriptors: |Negative descriptors: |
|Offers options to patient but explains cocp reduces Lamotrigine |Offers COCP |
|levels which may cause a fit with loss of driving license |Doesn’t discuss implications of pregnancy and epilepsy |
|Briefly explains pros and cons on POP, Depot and implant, coil. |Pros and cons of contraceptive options not discussed |
|More detailed explanation of Nexplanon and the logistics in practice of|Confusing explanations |
|having it inserted |No provision on condoms or emergency contraceptive advice pending |
|PIleaflet offered re LARCS and emergency contraception |Nexplanon insertion |
|Condoms offered |No shared plan |
|Pre-pregnancy & epilepsy advice or PILeaflet offered |No follow up or safety netting |
|Agreed plan and future follow up | |
|Assessment Domain: | |
|3. Interpersonal skills | |
|Positive descriptors: |Negative descriptors: |
|Establishes and maintain raport |Is judgemental |
|Non judegmental |Dismisses concerns |
|Able to respect and use ICE |Appears awkward and embarrassed |
|Shared decision making |Doctor centred |
| | |
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