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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Amanda and then negotiate an initial management plan with her. Your management plan will include explaining the need for a physical examination.

Scenario

Amanda Porter is a 16-year-old girl who has been coming to the practice for a long time. Last week during a school trip her class teacher caught Amanda making herself sick after the evening meal. With Amanda’s consent the teacher phoned to make this appointment.

The following information is on her summary sheet:

  • Past medical history

  • Greenstick fracture left radius aged eight

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Fully immunised

  • Social history

  • Lives with parents.

INSTRUCTIONS FOR THE PATIENT, AMANDA PORTER

Your family have always had ‘big bones’. As a child you accepted the fact that your mum and dad were on the sidelines at sports day rather than entering in the parents’ races. You are used to being part of a big family and shopping at the plus size stores. Whenever friends visit they can’t finish the amount of food they are given.

About three months ago you had a really bad attack of gastroenteritis. You were amazed to find that you lost weight. Losing weight made you feel great.

You found that if you made yourself vomit just after the evening meal at home you could lose weight without having to diet. Although the vomiting is not pleasant it makes you feel good because your figure is better and you are getting attention from the boys at the youth club.

Last week during a school trip your class teacher caught you making yourself sick after the evening meal. Your teacher phoned to make this appointment with your consent. You are 1.67 m tall and weighed 95 kg three months ago, giving you a BMI of 34 kg/m2. You now weigh 89 kg (BMI 29 kg/m2).

You are very scared about seeing the GP.

The following information is on your summary sheet:

  • Past medical history

  • Greenstick fracture left radius aged eight

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Fully immunised

  • Social history

  • Lives with parents.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Confirm confidentiality assured—unless disclosure required by law

Sensitively explore Amanda’s ideas, concerns and expectations regarding the consultation.

Specific questions

Establish facts about the vomiting and weight loss

Exclude significant physical pathology

  • — Energy and general health

  • — Diet, appetite

  • — Fever, cough, sputum

  • — Nausea, vomiting, diarrhoea, bowel disturbance, abdominal pain, amenorrhoea

  • — Thirst, polyuria

Explore symptoms of an eating disorder using the SCOFF questionnaire:1...

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