GP Stage 3 Simulated Consultation - Patient 10
You are an SHO in General Practice. Your next patient is Michael, a 31 year old patient with Multiple Sclerosis.
You are Michael, a 31 year old patient with Multiple Sclerosis (progressive condition of the nervous system). Since your diagnosis 10 years ago, you have tried numerous medications on the advice of the neurologist, none of which have offered much benefit. Presently your symptoms are increasingly troublesome with progressive pain and loss of sensation in your left leg and right arm.
You have arranged to see the GP in order to find out if there are any new treatments that they can offer to assist with the pain. In particular you would like to know if the doctor can prescribe medical cannabis. Your friend has tried this to good effect and you have also heard many positive stories in the news and online. If the doctor states that he cannot prescribe this, you become upset and advise the doctor that you will have to buy this illegally and the doctor will be responsible if the medicine is contaminated. Additionally, in order to fund the purchases you will likely have to resort to your old habits of petty theft, for which you also feel the doctor is to blame.
In addition to obtaining this medication, you would appreciate if the doctor could refer you to an alternative neurologist, as you do not believe that the solutions offered by your present neurologist have been beneficial. Your main concern is that if you do not find a solution, your symptoms will progress and you will not be able to walk and look after yourself like one of your friends who was only diagnosed with multiple sclerosis 5 years ago.
Due to the severity of your symptoms, you are unable to work, with no regular income. You do not have any support at home and are unsure how to claim any financial or social support benefits.
This consultation is representative of an increasingly common dilemma faced in general practice. That being media-led medicine rather than evidence-based medicine. It is clear that Michael is frustrated and it is important to not escalate this with aggressive body language, but instead attempt to understand Thomas’ underlying concerns regarding progression of MS and identify mutually agreeable solutions. These include arranging Thomas to see an alternative neurologist, investigating alternative NICE approved MS treatments as well as arranging social and financial support which is likely available for Thomas.