GP Stage 3 Simulated Consultation - Patient 1
You are an FY2 running an afternoon clinic at the GP Surgery. Your clinic is running 30 minutes late after having to send Mr Jones, your previous patient into A&E with cardiac chest pain. Your next patient is Sam Kelvin who has been on an experimental medication for IBD. You have been advised by your GP supervisor that the trial has been ended prematurely due to unspecified side effects, and that no more trial medication is to be issued.
You are Sam Kelvin, a 35 year old patient with IBD who has received a telephone call regarding a trial IBD medication that you are taking, requesting that you arrange an urgent GP appointment to discuss the medication further. You are extremely angry and disappointed that you have taken time off work to arrange this ‘urgent’ appointment only to wait an additional thirty minutes in the waiting area to see the doctor. You would like to know exactly why you were made to wait an additional thirty minutes.
You are made even more angry to discover that you will no longer receive further supplies of your IBD trial medication, which you commenced last month. This is the only medication that has worked to settle your loose stools and abdominal pain, and feel betrayed after being told by the GP just last week that the trial will last a minimum of 3 months. You are losing trust in the medical profession, and would like information on how to make a complaint.
By profession, you are an actor and as a result of your numerous IBD exacerbations and hospital admissions (prior to commencing the trial medication) you have struggled to obtain long-term work. You fear that stopping the trial medication will lead to a further exacerbation, and thus compound your on-going employment challenges. You smoke 20 cigarettes/day as you have read this can reduce the frequency of your flares. At home, you live with your partner who is increasingly anxious regarding your unpredictable health. Despite the empathetic efforts of the doctor, you do not feel that the doctor fully understands your predicament, and would like to submit a formal complaint.
This case tests three key areas – maintaining confidentiality, appeasing upset patients and dealing with complaints. The initial challenge is to provide sufficient explanation as to why the clinic has been delayed, without divulging confidential information about Mr Jones’ presentation. Candidates breaching patient confidentiality in this case, will unfortunately be deemed unsuitable for GP training. Thereafter, candidates are tested on managing an angry patient, providing an appropriate apology as well as suggesting solutions. As per all consultations, it is essential to also address social and employment factors, in taking a comprehensive history.
Potential solutions include exploring whether there are alternative experimental medications that may be deemed safer and could offer similar symptom remission as well as further researching the exact reasons for the medication being withdrawn. Should the patient persist with their desire to make a formal complaint, it is important to be honest and provide information on how this can be done and the likely timescale for response. Finally, health promotion regarding cigarette smoking and the wider implications as well as arranging an appropriate follow up appointment would also be encouraged.