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.
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