Location: You are a foundation doctor in general surgery
Patient: Nurse has bleeped you to come speak to a 40 year old female patient who has been having hand pain and would like to talk to the doctor about this
– 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 40 year old female patient. You were admitted to hospital today with abdominal pain but that is all being investigated at the moment.
You want to talk to the doctor about your hand, as you were in hospital you thought it would be a good time to get it looked over.
You have been having pain in both hands for the past 6 months which as been at its worst overnight. If asked it is worse in your right hand, which is the hand you write with. You also get the pain when you are driving, reading or brushing your hair.
If asked you have some tingling in your thumb and index finger. Your grip feels like it is weaker than it has been in the past.
It sounds ‘silly’ but if you shake your hand the pain seems to get better. You often wake up with your hand dangled over the side of the bed.
You have seen your GP who thinks it is ‘all in your head’ but you are not stressed about anything in particular at the moment.
Type 1 diabetic
If specifically asked – you had a wrist fracture in your right hand about 15 years ago
No known drug allergies
You have never smoked
You drink a glass of rose a week
You live at home with your partner
You are worried this is all in your head and you are wasting everyones time.
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.