Location: You are a medical student in General Practice.
Patient: This is Emily Fulflood. She has booked an urgent appointment at the family practice. Please take a history prior to her seeing the doctor.
– Take a 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.
Your name is Emily Fulflood. You are 22 year old student. You are in your family practice to see a doctor because you have had diarrhoea. You quite distressed because of your troubling symptoms.
History of presenting symptoms
Information to be volunteered at the start
You have come in because of diarrhoea. Its been going on for 2 weeks and you feel awful. Its very loose and you are going 8-10 times a day. It contains fresh red blood mixed in with it. You feel like you need to go to the toilet most the time, even when you have just been. You often need to rush to the toilet. You have ‘never had a tummy bug like this before’.
Information to be given if asked
You have also had a mild intermittent crampy abdominal pain but you have not felt sick. You have not had a fever but do feel really tired. Your weight is stable. You have no other symptoms.
You have not eaten anything funny and everyone else in your hall is fine as far as you know.
Past medical history
Medications and allergies
‘The pill’. No allergies.
Parents fit and well. No siblings.
Social and personal circumstances
You are a university student studying economics. You do not smoke. You drink 1-2 bottles of wine when you go on a night out, which is usually 2-3 times each week. Your mum and dad live 5 hours away and you have a good relationship. You are single and have had unprotected sex with 2 different partners this year. You went on a weekend away in Dublin 3 weeks ago but have not travelled anywhere else.
Your ideas, concerns and expectations
You have not told anyone about this problem because its so embarrassing. You have got the the point where you are now missing university lectures because you might need to get up and rush to the toilet. You are worried that one of these times you may not make it.
Questions for the doctor