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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history, conduct an appropriate examination and then outline your management plan to Jeremy.

Scenario

Jeremy King is a 25-year-old plumber who comes to see you for review following a car accident. He was driving to work when a truck went very slowly into the back of his car while he was stationary at traffic lights. He attended the hospital emergency department where he was examined. The doctor did not think X-rays were needed1 and only did them following pressure from Jeremy. No fractures were identified.

Jeremy has returned for review a week after the accident. The brake and indicator light of Jeremy’s work ute needed replacement but otherwise it was fine.

The following information is on his summary sheet:

  • Past medical history

  • Nil

  • Medication

  • Nil

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Self-employed plumber.

INSTRUCTIONS FOR THE PATIENT, JEREMY KING

You are a 25-year-old self-employed plumber. Your business has been going badly and you have been getting increasingly tired and frustrated at work. You have wanted to take time off but cannot afford to.

Last week you were driving to work when a truck went very slowly into the back of your work ute while you were stationary at traffic lights. You attended the hospital emergency department where you were examined. The doctor said that you did not need X-rays but you insisted that they do some; no fractures were identified.

You have come to see your GP for review a week later.

The brake and indicator light of your work ute needed replacement but otherwise it was fine.

The truck driver’s insurance company has already arranged for the repairs to your car, so you could get back to work next week. You have had one week off but want to take more time out. Your neck was a bit sore after the accident and you get mild pain at the end of the day. You have no other residual symptoms.

You want the GP to sign you off for more sick leave.

Clinical examination findings

Clinical examination is normal. There is a full range of pain-free movement.

The following information is on your medical record:

  • Past medical history

  • Nil

  • Medication

  • Nil

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Self-employed plumber.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Open-ended questions to establish Jeremy’s ideas and concerns about his injury, and expectations of this consultation.

Specific questions

Further history regarding neck pain

  • — Interference with sleep, activities of daily living

  • — Treatment so far

    ...

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