GP Stage 3 Simulated Consultation - Patient 13
You are an SHO in medicine and one of your patients, Mr Anthony Helston has asked to speak with you. Mr Helston was admitted one week ago with a urinary tract infection and delirium, although he has since demonstrated some improvement.
You are Mr Anthony Helston, a 58 year old gentleman admitted to hospital with a severe urine infection and resultant delirium (confusion). You have demonstrated some improvement since you were admitted and you would like to speak with the doctor about a couple of your concerns.
Your first concern relates to the staff nurse Vicky who has been looking after your bay of patients for the last two days. You are concerned that Vicky is adding an unspecified liquid to patient’s medications as you have seen her discreetly taking a vial out of her pocket for two of the patients receiving intravenous antibiotics (antibiotics through the vein), both of whom have deteriorated in the last couple of days. Fortunately, for yourself you have been switched to oral antibiotics and so Vicky has not been able to contaminate your medication. You would like the matter investigated and Vicky suspended to ensure that she cannot contaminate further medication.
Your second concern is that you believe the ward physiotherapist is causing patients to fall, given that two of the ward patients have come back with falls following physiotherapy sessions. You have not personally seen the physiotherapist push or harm any patients, however you have observed the patients post physiotherapy including their bruises. Mr Thomas mentioned to you that his elbow bruise was following a fall with the physiotherapist. Similarly you would like this investigated promptly.
Any doctors suggesting that your observations are clouded by your urine infection or underlying confusion result in you becoming more angry, questioning whether the doctor is also negligent and needs to be investigated. Cognitively you are otherwise alert and are able to answer the doctor’s questions appropriately.
You are otherwise well, and do not have any additional concerns regarding the quality of the care that you have received, and are personally pleased with your improvement. You work as an investment banker and are keen to return to work. At home you live with your wife and two children, all of whom are well. You are generally independent and do not smoke or drink alcohol.
This is a relatively common occurrence in hospital, especially in cases of acute delirium. However, given that it appears that Mr Helston is clinically improving, it would be inappropriate to attribute his accusations to underlying confusion and as such these concerns must be investigated appropriately. It may well be that Mr Helston is misinterpreting normal hospital occurrences for example the vials may represent saline flush, and similarly it is possible for patients to fall during physiotherapy without being ‘pushed’ by medical professionals. As such, it is important to find a balance between ignoring Mr Helston’s observations and contrastingly assuring him that the relevant staff members will be suspended pending investigation. As always, exploration of home and social circumstances is important in taking a complete GP Stage 3 history.