Location: Foundation doctor in general practice.
Patient: 17 year old female patient has come to discuss contraception
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 a 17 year old patient, currently living at home with your mum and dad, you are in your last year of A-levels and you are planning to go to university in September. You have come to the doctors today as “I would like to start taking the pill”, your friends have started taking the pill and this has worked really well for them.
You have been in a relationship with a male partner (also 17) for the past year.
Your last period was 3 weeks ago. Your periods are regular every 4 weeks, you menstruate for 4 days. You do not experience any breakthrough bleeding in-between your periods.
You do not experience any pain during sex. You do not have any abnormal discharge.
You always use “protection” when you have sexual intercourse and only use condoms.
PMH – you are usually fit and well, you were previously treated a couple of years ago for an ear infection. No previous operations.
DH – no regular medication / OTC / herbal
SH – you do not smoke, you drink less than a glass of wine a week.
FH – no family history of VTE (DVT / PE ect.), cardiovascular disease or breast cancer
ICE – Ideas – you think the pill is more effective than condoms. – Concerns – that you do not want to become pregnant if you don’t start taking the pill – Expectation – Prescription for the combined pill
If asked you have read about the different types of contraception on the internet and you are interested in taking the pill. You do not like needles and you are not interested in patches / implants / coils
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.