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INSTRUCTIONS FOR THE DOCTOR
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Please take a history as if you were in clinical practice and then outline your plans to Mrs Worthington.
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Scenario
Mrs Nell Worthington is an 80-year-old retired legal secretary. She has hypertension. She has just moved to your area to be nearer to her daughter. She has brought her summary sheet from her previous practice.
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The following information is on her summary sheet from her previous practice:
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Past medical history
Hypertension diagnosed 2013
Osteoarthritis of neck and hips
Vaginal hysterectomy for prolapse 1995
Four children
Medication
Spironolactone 25 mg od
Ramipril 10 mg od
Potassium chloride 600 mg slow release 1 tab od
Allergies
Nil known
Immunisations
Up-to-date
Social history
Widowed 2008.
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INSTRUCTIONS FOR THE PATIENT, NELL WORTHINGTON
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You are an 80-year-old retired legal secretary. You have just moved to be nearer your daughter. Life has been hard since Vince, your husband, died in 2008. You are feeling lost as you try to establish your new life in this town. You had attended the same doctor back home for years and are nervous about coming here today.
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You have been feeling lethargic recently but have put this down to the move. Your opening line will be, ‘Doctor I’m feeling tired, but maybe this is because I have just moved here.’
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The following information is on your summary sheet:
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Past medical history
Hypertension diagnosed 2013
Osteoarthritis of neck and hips
Vaginal hysterectomy for prolapse 1995
Four children
Medication
Spironolactone 25 mg od
Ramipril 10 mg od
Potassium chloride 600 mg slow release 1 tab od
Allergies
Nil known
Immunisations
Up-to-date
Social history
Widowed 2008.
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SUGGESTED APPROACH TO THE CASE
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Welcome Mrs Worthington to the practice
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Explore patient’s ideas, concerns and expectations regarding this consultation.
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Enquire about current symptoms
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Brief systems review—any problems with your breathing, your appetite, your bowels, your ‘waterworks’, sleep, energy level, weight changes?
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Sensitively explore any mood symptoms
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Review information on summary sheet with Mrs Worthington
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Confirm current medication
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Explore other cardiac risk factors
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Other preventive health measures
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— Immunisation status
— Alcohol consumption
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Full physical examination—needed, but not part of this consultation.
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Explain need for investigations
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Surgery tests: BSL or urine dipstick, ECG
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