Location: You are a foundation doctor in general practice
Patient: 85 year old female patient. The GP booking system comment says “right hip pain”
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 an 85 year old female patient.
Open with “My hip has been playing up, i think i need some more painkillers.” If asked to elaborate on the pain say “it’s been there for a while and it has just been getting worse.”
You have finally now come to the doctors because you are struggling to walk your dog Tilly as much as you would like because of the pain. The pain is not allowing you to socialise as much and your dog getting more upset.
You have been having left hip pain for the past 6 months. It is a nagging sort of pain which has been getting gradually worse. The pain is worse on exertion and seems to get worse throughout the day. You have noticed sitting down and watching TV helps the pain.
You are starting to struggle to get out of the bath and embarrassingly you have had to call your daughter a couple of times to help you get out.
You have been taking paracetamol regularly which at first seemed to help with the pain but now isn’t even touching it.
You have no joint swelling or redness. There is no clicking or locking of the joint. You have had no recent fall or injury. No weight loss or previous history of cancer.
If directly asked about your ideas, concerns or expectations, you have delayed coming to the doctors as you are worried about needing a hip operation. You neighbour had to have a knee operation and she has never been the same since, you are worried this is going to happen to you. You do not want an operation and would prefer to be managed by the GP. You think an x-ray and painkillers would be the solution.
PMH – High blood pressure
DH – Ramipril 10mg – No known drug allergies
FH – Nill
SH – You started smoking when you were 15 and gave up at the age of 30, you used to smoke 10/day – You drink a glass of port each Sunday – You live alone in a bungalow with your dog Tilly – You have no carers but your daughter lives around the corner – You are a retired factory workers making pencils
ICEF – As above
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.