INSTRUCTIONS FOR THE DOCTOR
Please take a history, conduct a focused examination and outline your diagnosis and management plan to the patient.
Ruby Chan is 40 years old and works long hours at the local club. She has booked this appointment to see you because of facial pain.
You practise in a small rural town of 600 people. You are the only resident health professional.
The following information is on Ruby’s summary sheet:
INSTRUCTIONS FOR THE PATIENT, RUBY CHAN
You are a 40-year-old woman who has had facial pain for a few days. It is getting worse and it kept you awake last night. You have had a cold and are overdue for a check-up at the dentist. The nearest dentist is over 50 km away. The pain is worse when you chew food. You have a slight headache but this does not get worse on bending forwards or sneezing. Your sense of smell is undisturbed.
Your father died of cancer of the tongue. You have never been sure exactly what this is, but it does mean that you are more concerned than normal about your pain being something serious. You would like the doctor to find this out but will not reveal this unless asked appropriately.
Instructions for the facilitator
The candidate should perform a focused oral examination.
Clinical examination findings
Tapping of one of your molars gives you significant pain.
The following information is on your medical record:
SUGGESTED APPROACH TO THE CASE
Open-ended questions to explore Ruby’s ideas, concerns and expectations.
Ask about the pain, e.g. using OLD CARTS acronym
Exclude systemic symptoms—weight changes, energy level, sleep disturbance
Request permission to examine.
Inspect and/or palpate head and neck
Check teeth, lymph nodes, skin, eyes, salivary glands, temporomandibular joint, cervical spine, nose, mouth, pharynx and post-nasal space ...