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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from your regular patient, Samantha Heyward. The facilitator will give you the results of any relevant physical examination on request. Then outline a management plan with Samantha.

Scenario

Samantha Heyward is 21 years old and her family have been your patients for many years. She has mostly enjoyed good health and has been on the oral contraceptive pill for about five years, initially for irregular periods and then for contraception.

She has also had some depression, which got quite severe during her final year of school and she has been on sertraline since then. She has tried a couple of times to stop taking it, but within a month or so her mood drops and she recommences. Sam has a close relationship with her parents and has two older brothers who are both married with children but live nearby. You see Sam every several months and at her last appointment she was doing well. She told you she had a new boyfriend, Glen, and was enjoying her work as a clerk in the courthouse.

The following information is on her summary sheet:

  • Age

  • 21

  • Past medical history

  • Depression

  • Medication

  • Sertraline 100 mg od

  • Ethinylestradiol 30 mcg/levonorgestrel 150 mcg (Microgynon 30) one daily

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Non-smoker

  • Non-drinker.

INSTRUCTIONS FOR THE PATIENT, SAMANTHA HEYWARD

Your name is Samantha (Sam) Heyward and you are a 21-year-old long-term patient of this doctor. You’ve had some trouble with depression in the past but have generally been healthy. You have come to the doctor because you are confused. You are having problems with your partner, Glen, and are not sure which one of you is normal and who is ‘to blame’. Your opening line can be something like, ‘Glen and I are having problems and I don’t know if there’s something wrong with me or him’.

Let the candidate ask questions to draw the story out. You are initially somewhat embarrassed and reticent but respond to the doctor’s approach. If the doctor seems embarrassed, you can become more shy and awkward. Alternatively, if the questions are being asked skilfully in a relaxed manner, you can also relax and open up more.

You’ve been living with Glen for about nine months now and have been together for a little over a year. He seems really nice but you’re having problems in the ‘bedroom department’ and this is starting to affect your relationship. He wants to have sex a couple of times a day and perpetually seems excited and ready. At first you didn’t mind because you thought it would settle down with time, but it hasn’t.

As far as you are concerned, sex is enjoyable and you feel you have a healthy interest and ...

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