Location: Junior doctor on medical clerking, you have been bleeped by the ward sister
Patient: 20 year old patient has been referred by her GP for a cough has now developed abdominal pain and is tachypneic
– Take a focused history from the patient
– Perform a full ACDE assessment, a nurse will be available to help you with investigations or management that you require
– After 6 minuets 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 were admitted into hospital this morning with a cough from your GP, you have not been seen by the doctor yet. Your tummy has started hurting, it’s a 10 out of 10 for pain. You cannot even focus on what the doctor is saying because you are in so much pain. You keep asking for painkillers when the doctor is asking questions.
If specifically asked you are diabetic, you have not had any of your insulin yet because the nurses have said the doctors have no prescribed it yet. The last time you had your insulin was last night and you have been eating throughout the day.