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INSTRUCTIONS FOR THE DOCTOR
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Please take a history from Jill and ask for the physical examination findings from the facilitator. Talk to Jill about your initial diagnosis or concerns and discuss an initial plan of management with her.
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Scenario
Jill Krecher is a 29-year-old woman who has been to the surgery four times for minor ailments in the last few months. The receptionist told you she sounded teary on the phone when she booked for an appointment today.
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The following information is on her summary sheet:
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Past medical history
Anxiety—treated 2013–14
Menorrhagia—inactive
Medication
Mirena inserted September 2017
Allergies
Nil known
Immunisations
As per schedule
Social history
Teacher at local primary school
Lives with fiancé Paul, who is an accountant
Non-smoker
Social drinker with friends on the weekend
No recreational drugs
Family history
Dad—hypertension
Mum—osteoarthritis knees.
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INSTRUCTIONS FOR THE PATIENT, JILL KRECHER
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You have asked to see the doctor urgently as you can’t teach today due to your bruises. You have a black eye, which you can’t cover with make-up and bruises on your arms. Your partner Paul has become increasingly violent. You haven’t been able to tell anyone and have hidden the bruises. This weekend he has been very violent. He’s never hit you in the face before.
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You have had some time off work recently as his behaviour has been upsetting you so much, but you’ve told the doctors it’s either gastro or a viral illness.
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Today you think the doctor will probably notice the bruises and if they ask you will tell them what’s going on. You feel so much shame about being in this situation you can’t bring it up unprompted.
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Initially, tell the doctor you’ve had trouble sleeping and don’t think you can teach today.
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If you trust them and they ask questions about your situation you will tell them you had an argument with your partner and ‘things have been a bit rough lately’. If they ask about violence or if you feel safe you will confide in them.
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You’ve been with Paul for two years. The first year he was like a dream come true and he swept you off your feet. All your friends and family loved him too. But he then became jealous and slowly you’ve stopped seeing friends and family.
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He first hit you six months ago after a male colleague chatted to you at a local café. He thought you were cheating. His violence is getting more frequent and last night he strangled you until you almost passed out.
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Your friends seem worried about you, but they have stopped ringing as often as you have been withdrawn.
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There are no children involved.
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