+++
INSTRUCTIONS FOR THE DOCTOR
++
++
Please conduct this consultation as you would in clinical practice.
++
Scenario
Vikki Nicolaides is a 34-year-old accountant. She and Nico, her boyfriend, have been together for four years and they are considering starting a family. She has made this appointment to find out about when to stop the pill.
++
The following information is on her summary sheet:
++
Past medical history
Glandular fever
Mild anxiety—postgraduate exams 2005
Medication
Ethinyloestradiol 30 mcg/levonorgestrel 150 mcg (Microgynon 30)
Allergies
Nil
Immunisations
Nil recorded
Cervical screening
2018 normal
Social history
Parents migrated from Cyprus in 1960s
Non-smoker
Binge drinking at university.
+++
INSTRUCTIONS FOR THE PATIENT, VIKKI NICOLAIDES
++
You are 34 years old and work long hours as an accountant. Over the past year you have been discussing with your boyfriend the possibility of starting a family. You want to find out from the GP when to stop taking the pill and would be happy to have any other advice that you are offered.
++
You have regular periods on the pill and your BMI is 24 kg/m2.
++
Your Mum and sister have diabetes. They were both diagnosed in their 30s. Your maternal grandmother is now on dialysis due to her kidney trouble and also was diagnosed young with diabetes. But they’re all heavyset and you think you got your Dad’s genes. You’re hoping this won’t be an issue for you.
++
The following information is on your medical record:
++
Past medical history
Glandular fever
Mild anxiety—postgraduate exams 2005
Medication
Ethinyloestradiol 30 mcg/levonorgestrel 150 mcg (Microgynon 30)
Allergies
Nil
Immunisations
Up-to-date
Cervical screening
2018 normal
Social history
Parents migrated from Cyprus in 1960s
Non-smoker
Binge drinking at university.
+++
SUGGESTED APPROACH TO THE CASE
++
++
Open questions to explore Vikki’s ideas, concerns and expectations regarding this consultation
++
++
++
Briefly review past medical history—include drug use (prescribed, over the counter and illicit), exclude diabetes, epilepsy, depression
++
++
Tailor advice to the answers given to the questions above, plus:
++
++
— Folic acid (500 mcg od) and iodine supplements (150 mcg od)
— Avoid eating liver
— Eat fish twice a week
— Hygiene—fresh food, care with cat litter
— Avoid environmental toxins
++
++
++
++