Location: Foundation doctor in orthopaedic day surgery
Patient: Was due to have an operation this morning as a day case for an arthroscopy and medical meniscectomy.
All routine surgery lists (including the patients operation) have had to be cancelled today at short notice as there has been a serious road traffic accident during the night which requires the need of all the operating theatres and beds.
Task, you are allowed the say the following:
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 55 year old patient who has arrived on this ward this morning, expecting to have your knee operation. You have had all the booking checks including your observations and the nurses have put you in this room as you ‘need to speak to the doctor,’ this is as much as you know at this point.
You have been waiting for something to be done on your knee for about 1 year. It took your GP almost 6 months to refer you and kept saying it was a sprain and wanted to ‘give it time to heal’. You then had to wait a further 3 months to get a special scan of your knee which showed the cartilage was badly torn and you needed to have an operation.
You are very keen to get this operation done and you feel that you have already waited far to long already. The quality of the service from the staff has been excellent but you feel that the NHS is over stretched.
If the candidate communicates well, displays appropriate empathy then share the following concerns:
You are a self employed carer and your poor knee is severely affecting your ability to do your job. You cannot bend fully and it locks and gives way. It aches all the time and it is affecting your job. You are worried about your financial situation and cannot afford to reduce your hours any more or take time off work.
Overall = you are angry and pick up on every small detail, you are upset and raise your voice. You are not reasonable and do not have insight into the situation. When the doctor mentions about the road traffic accident you say “you are just trying to guilt me into this by making me seem like a bad person”. You say “i pay taxes, so i demand this is done today”, “this isn’t good enough and i want to make a complaint against you personally”
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.