Location: You are a medical student in General Practice.
Patient: 19 year old student who has had poor attendance at university.
– 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.
You are a 19 year old, currently at university. You did not want to come to the general practice doctor today but your hall counsellor has made you come because you have missed over 50% of your lectures. As far as you are concerned you don’t have a medical problem and you don’t know why they made you come to the doctors.
Demeanour: Speak slowly and quietly and avoid eye contact as much as possible. Look down in your lap. Occasionally look around the room suspiciously. Initially act scared of the doctor and only give short, one line answers. Make the candidate build some rapport and trust before you divulge any information.
History of presenting symptoms
Information to be volunteered at the start
Your hall counsellor has made you come because you have missed over 50% of your lectures.
Information to be given if asked
When probed about why you have missed lectures, divulge that you try not to leave your room because your hallmates gang up on you and are trying to get you evicted. Sometimes they are able to put thoughts into your head and control your actions. You keep the curtains closed because they sometimes shine rays into your room to try and burn you. Ask if the doctor can help you get a protection order.
If probed, admit that you do sometimes hear voices talking about you. They never speak directly to you or give you instructions.
If asked about harming yourself or suicide, get angry with the doctor and ask them if they think you’re mad. You have no intention of hurting yourself or committing suicide. You do not want to hurt anyone else but have brought a knife with you today for protection, incase you hallmates try to harm you. If the doctor speaks about treatment, refuse because you are not ill.
Past medical history
Type 1 diabetes; you once cut your wrists 1 year ago if asked specifically about self harm.
Medications and allergies
Insulin injections (novorapid 5 units with meals, lantus 20 units in evenings). No allergies.
Social and personal circumstances
You are at university studying English. You drink 2-3 cans of beer each evening in your room. You do not smoke cigarettes but occasional smoke cannabis. Your mother died when you were young of an overdose and you were brought up by your stepfather who you don’t get on with. You never met your father and have no siblings.
Your ideas, concerns and expectations
Questions for the doctor