Location: You are a junior doctor in general practice.
Patient: 60 year old patient has attended clinic, the computer system says “related to recently deceased partner”. You read through the notes and see that patient had been seen by a FY2 and prescribed omeprazole for indigestion 6 months ago. Was then seen again by the GP a month later and prescribed omeprazole on repeat. A letter from the hospital two weeks ago shows the patient has passed away, CT scan showed pancreatic cancer and a post mortem is to be held at the request of the family.
Task: – Gather the reason for attendance – Answer any questions 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 may be required.
You are a 60 year old patient.
You and your partner came to see a trainee doctor at the practice 6 months ago. They said it is indigestion and prescribed a trial of omeprazole. This appeared to help a little but nowhere near what she used to be. The couple returned and saw another GP who prescribed the omeprazole again. A couple of months later your partner started to go yellow, felt very itchy and one night would not stop vomiting. You called ambulance and was taken to hospital. CT scan showed advanced pancreatic cancer with metastasis. A couple of days later your partner passed away in the hospital.
You are extremely annoyed, upset and frustrated about the last 2 months. You were told in the hospital that the signs of pancreatic cancer where there at the first appointment. Your partner was not examined, no blood tests, no scans and no follow up.
You believe if this was still done that your partner would still be alive now. You want to make sure no body else goes through what you are experiencing now and you want this junior doctor to be punished. You wish to make a formal complaint.
If the doctor asks about signs of depression, you show no symptoms of this, you are angry at the care your partner has received.
Ideas – you believe your partner would be alive if the foundation doctor did their job correctly
Concerns – that this could happen to another patient
Expectations – you want to make a formal complaint in order to ensure this does not happen again
Overall role = you are annoyed at the foundation doctor. You do not understand any medical jargon and require it to be explained if said by the candidate. You need to give the candidate opportunity to break down this station, you are required to give very long pauses in order to make the station uncomfortable. Make use of non-verbal cues if appropriate to show both happiness and sadness e.g hands on face covering eyes, shaking of head, ect.
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.