Location: You are a junior doctor in general practice
Patient: 18 year old female has made an appointment to talk about her skin
Task: – Take a focused history from the patient – After 6 minutes you will be asked a series of questions by the examiner. – Answer any questions that the patient may have
Note to actor: Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.
You are an 18 year old female university student who is really embarrassed about talking about your skin. You have recently moved to the area, so you have not seen a GP here yet but you have seen another GP in a different area of the country several times who said you would grow out of it and it was not that bad.
You believe you have bad acne on your face. You get a lot of blackheads and white bumps. You get some sore red bits and these are very painful.
Your acne is worse around the time of your period (if asked your cycles are regular). You noticed when you have been on holiday in the sun, your skin has much improved and you have on occasion used a sun bed as well to get the same effect, although you try to avoid doing this to often as you are aware of the risk of skin cancer.
You have gotten to the point now where you do not want to go out in pubic, you have stopped attending university as you are worried that new people will judge you because of your skin. Everyone you see at university has great skin.
You are worried because your mother had terrible acne as a child at it has left some quite large scars on her face and you are worried this is going to happen to you.
Your mum is convinced your bad skin is due to not washing properly. You have started using face wash with the gritty bits in them to help, although this seems to of made things worse! Your mum also believes that foods such as burgers, fries and chocolate cause spots, so you have cut these out your diet all together.
You have been prescribed an antibiotic by your previous GP for about 2 weeks but this did not seem to help. You have tried all the spot treatments from the supermarket but these have not appeared to make a difference.
PMH – Usually fit and well
DH – No regular medications – No known drug allergies
FH – Mum had severe acne
If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection.