GP Stage 3 Simulated Consultation - Patient 2
You are an FY2 doctor on an acute medical ward. One of your patients, Mr Thomas has asked to speak to you before he is discharged regarding his new diagnosis of Type 2 Diabetes. Mr Thomas is a 50 year old gentleman who had a brief admission with troublesome polyuria and polydipsia, and has been commenced on Metformin.
You are Mr Thomas, a 50 year old bus driver who has just been diagnosed with Type 2 Diabetes during a recent admission. You have asked to speak to the doctor to obtain further information regarding your recent diagnosis.
You have a number of concerns regarding your new diagnosis, in particular pertaining to your work as a bus driver. You have heard that diabetes can affect vision, and are concerned that this may prevent you from continuing your job. Additionally, with the increased urinary frequency prior to your hospital admission, you feel embarrassed at having to regularly interrupt your work so that you can go to the bathroom. You are hoping that the doctor can suggest some solutions to prevent this from continuing to interrupt your life.
At home, you live alone with your wife having recently divorced you. This has significantly affected your mood, and you would like someone to talk to about this, although you are reluctant to verbally volunteer this information regarding your mood and instead demonstrate this through your depressed non-verbal behaviour. Following the divorce, you have been drinking increasing amounts of alcohol (4 pints/day) as well as smoking 30 cigarettes/day.
This consultation has three areas of focus. The primary and clearly stated requirement is to provide Mr Thomas with an explanation regarding his new diagnosis of diabetes in a jargon free comprehensible manner. Candidates using medical terminology will score poorly and be restricted in the additional information that will be volunteered by Mr Thomas. Thereafter, candidates are expected to explore additional concerns in relation to work and home challenges faced by Mr Thomas. Excellent candidates will recognise Mr Thomas’ blunted affect (non-verbal cue) and proceed to ask further questions in relation to possible depression as well as the recreational (alcohol/smoking) implications for Mr Thomas.
Appropriate management approaches include outlining the sources of support for newly diagnosed T2DM (DESMOND, Diabetes Nurse etc.) as well as advising regarding DVLA guidelines for Class 2 drivers and the need for regular review/follow-up of potential complications. With regards to Mr Thomas' mood, offering a referral to an IAPT Service (eg. Wellbeing Service) as well as arranging appropriate follow up in 1-2 weeks would be encouraged.