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INSTRUCTIONS FOR THE DOCTOR

This is a short viva station.

Please discuss your management of this situation with a GP colleague.

Scenario

You are working an evening clinic in general practice and a patient of your practice, Kaitlin Johansen, comes in unexpectedly, tearful, reporting she has been raped at a party. Your last patient cancelled, so you can see Kaitlin now.

The following information is on her summary sheet:

  • Age

  • 19

  • Past medical history

  • Asthma

  • Medications

  • Fluticasone 250 mcg/salmeterol 25 mcg (Seretide) 1 puff bd

  • Salbutamol inhaler 100 mcg 1–2 puffs prn

  • Social

  • Studying beauty therapy

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Cervical screening

  • None.

INSTRUCTIONS FOR THE FACILITATOR

This is a viva station. Please ask the candidate the following questions about the case:

  1. What are your immediate medical (including psychological) concerns for Kaitlin?

  2. She tells you that she does not want to involve the police. How would you respond?

  3. You arrange for the Sexual Assault Referral Centre to perform a forensic examination in two hours. She needs to go to the toilet. Is there anything you need to advise her?

  4. Tell me the important things to consider about your notes regarding this consult?

  5. What follow-up will you arrange for Kaitlin?

SUGGESTED APPROACH TO THE CASE

  1. Medical priorities

    Physical injuries: assess Kaitlin with an initial primary survey and then more detailed secondary survey for specific injuries.

    STI screening and bloodborne viruses: possible prophylactic treatment for chlamydia, gonorrhoea, HIV and syphilis, and hepatitis B immunisation depending on her predicted risk.

    Pregnancy prevention: offer emergency contraception.

    Mental health: assess Kaitlin’s current mental state, and her ongoing safety and support. She may wish to call a support person and may need help to find a safe place to go following examination.

    Most areas have a Sexual Assault Resource Centre (SARC) and/or telephone hotline which provide expert support. General practitioners often follow up patients who have experienced trauma.

  2. When alleged assault is disclosed it is important to offer police involvement. As an adult, this is Kaitlin’s choice. If she would like to report the offence you can call the police immediately. However, if she doesn’t wish to involve them, then forensic specimens can still be collected in case she changes her mind. Forensic specimens have to be collected promptly.

  3. Contact the local SARC services and establish the most appropriate place for a timely forensic examination. If there will be some waiting time and Kaitlin is wanting to go to the toilet you might be asked to collect initial forensic samples, such as gauze swab of perineum and anal region, first pass urine and mouth washings, depending on details of the assault. SARC staff will help you decide necessary initial specimens.

  4. Your notes may be used in legal proceedings so they must be written objectively and without judgement. Contemporaneous ...

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