Approaching a Back Pain scenario

Examiner feedback from the free mock session conducted on 12/06/24

General Approach and Key Points

• Patient-Centered Care: Focus on treating the person, not just the disease. Understand how the patient's condition affects their life and address their main concerns.

• Empathy and Interpersonal Skills (IPS): Show empathy by acknowledging the patient's distress and offering immediate relief, like painkillers, even if they refuse. Address visible signs of discomfort and validate their feelings.

Data Gathering

• Initial Steps:

  • Introduce yourself and confirm the patient's full name and age.

  • Identify the setting (A&E) and the patient's background (young, trauma-related).

• Presenting Complaint:

  • Ask about the incident that caused the pain.

  • Use SOCRATES (Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/Relieving factors, Severity) to elaborate on the pain.

• Differential Diagnosis (DDs):

  • Start thinking about possible diagnoses (e.g., disc prolapse, cauda equina syndrome).

  • Rule out serious conditions first (e.g., ask about numbness in the anal region, bladder/bowel dysfunction).

• Holistic View:

  • Understand the patient's daily activities and how the pain impacts them.

  • Ask about past medical history, current medications, allergies, family history, and home conditions.

  • Inquire about work and any concerns related to employment and driving ability.

Management and Investigations

• Examinations:

  • Perform relevant physical examinations (neurological, lower limb, general physical, straight leg raising test).

  • Conduct investigations (full blood count, ESR, CRP, urine dipstick).

• Diagnosis and Explanation:

  • Explain the provisional diagnosis (e.g., intervertebral disc prolapse) and the reasoning behind it.

  • Address any misconceptions the patient may have about their condition.

• Treatment Plan:

  • Suggest appropriate medications (e.g., paracetamol, NSAIDs, muscle relaxants, steroids).

  • Refer to specialists (neurologists, orthopedics) for further tests and management.

  • Explain the role of physiotherapy and occupational therapy in managing the condition.

• Holistic Management:

  • Consider the patient's employment and possible adjustments (e.g., speaking with the manager, assessing work environment).

  • Provide resources like Citizen Advice Bureau for job-related support.

Closing the Consultation

• Safety Netting:

  • Advise the patient to return if they experience severe symptoms like loss of bowel/bladder control or numbness.

• Follow-Up:

  • Arrange follow-up with the GP or relevant healthcare provider to monitor progress and address ongoing concerns.

• Educational Materials:

  • Provide leaflets and pamphlets for additional information and self-management tips.

Summary of Key Steps

• Beginning:

  • Introduce yourself, confirm details, understand the setting.

  • Address immediate pain and show empathy.

• Middle:

  • Gather detailed information using SOCRATES.

  • Rule out severe conditions, understand the patient's lifestyle, and perform relevant examinations.

• End:

  • Explain the diagnosis and treatment plan.

  • Safety net, follow-up, and provide educational materials.

Tips for Success

• Always incorporate the patient's concerns and lifestyle into the management plan.

• Use empathy and interpersonal skills to build rapport and trust.

• Ensure comprehensive data gathering and a holistic approach to management.

• Prepare to close the consultation effectively by safety netting, scheduling follow-ups, and providing educational resources.