Location: You are a foundation doctor in general practice
Patient: 70 year old male patient can come to see you with lack of energy and feeling stiff
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 70 year old male patient.
You have come to see the doctor as you have no energy at the moment and you feel very stiff. You live at home with your dog Alex, who you usually walk everyday. At the moment you feel so stiff that you are struggling to take her for a walk. You are getting annoyed with yourself as your son is having to come around to take her for a walk.
This has been worse over the past month. The pain and stiffness is present in both shoulders and hips and is worse overnight and in early morning. The stiffness usually lasts about 1 hour in the morning. You have been struggling to use the stairs, particularly in the morning. You cannot get out of the bath and have had to get your son around to help you out the tub. You cannot also brush your hair in the morning.
You have no joint swelling or redness. You have no scalp tenderness or visual problems.
PMH – High blood pressure
DH – Amlodipine 10mg – No known drug allergies
SH – You used to be a heavy smoker but now you only have one or two a day – You drink a glass of port each evening – You live alone with your dog Alex – You are a retired butterfly farmer
ICEF – You are worried this is all in your head and you are wasting everyones time.
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.