Location: You are an F1 in general practice
Patient: A 60 year old patient has attended clinic with a change in bowel habit
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’re a 60 year old patient who’s attended your GP surgery with a change in bowel habit. You’ve only come because you told your partner and they keep nagging you to see the GP. You think this is all a waste of the doctor’s time as they have much sicker patients to see.
You’ve noticed over the past 3 months that your stools are a lot looser and you’ve been having to use the toilet more frequently. When you are on the toilet you feel like you cannot quite get everything out. If asked, you’ve noticed some blood intermittently mixed in with the stools, although it is not there all the time.
If directly asked you’ve noticed some weight loss of about 3kg over the past 2 months although you’ve not been trying to loose weight. You are more tired than usual too.
No rashes, joint pain or eye symptoms
PMH – Hypertension – No previous operations
DH – Amlodipine – Ramipril – NKDA
SH – You smoke about a pack of cigarettes a day and have done so for the past 20 years – Drink about a bottle of red wine a week
FH – Your dad had problems with his bowels for many years but you do not know anymore about that because he refused to talk about it