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INSTRUCTIONS FOR THE DOCTOR
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Please take a history. The facilitator will give you the results of the examination on request. Then negotiate a management plan with the patient.
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Scenario
Costa Rinaldi is a 36-year-old man. He rarely comes to see the GP but has booked an appointment today because his girlfriend sent him. They want a family but have not achieved a pregnancy after a year without using contraception. Costa’s girlfriend has a child from a previous relationship.
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The following information is on his summary sheet:
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Past medical history
Chickenpox aged 11
Medication
Nil
Allergies
Nil
Immunisation
Nil recorded
Social history
Works as an engineer.
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INSTRUCTIONS FOR THE PATIENT, COSTA RINALDI
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You are 36 years old and work hard as an engineer. Over the last few years you have put on weight and now have a BMI of 35.5 kg/m2. You have always been keen to have a family and were delighted to meet Brenda. You want to start a family with her.
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You have a great sex life but it is getting you down that Brenda is not pregnant. You have not used contraception for a year. You have a constant reminder that the lack of pregnancy is probably your problem, as Brenda’s 6-year-old daughter from a previous relationship lives with you.
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This problem is beginning to affect your work and your relationship with Brenda. You do not smoke and you drink at least five bottles of wine a week. You have heard that some childhood infections can cause infertility and you are worried that the chickenpox is to blame. Brenda has sent you to this appointment.
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You have no genitourinary symptoms.
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The following information is on your summary sheet:
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Past medical history
Chickenpox aged 11
Medication
Nil, no supplements
Allergies
Nil
Immunisation
Nil recorded
Social history
Works as an engineer.
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INSTRUCTIONS FOR THE FACILITATOR
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Clinical examination findings
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On specific request please give the doctor the following results:
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Abdominal examination—normal
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Genitalia—normal testicular and penile examination; no varicocele.
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SUGGESTED APPROACH TO THE CASE
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Open-ended questions to explore Costa’s ideas, concerns and expectations about the problem and the consultation.
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General health—fever, systemic malaise, weight loss
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Sexual function/genitalia
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— Frequency of coitus
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