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GP Stage 3 Simulated Consultation - Patient 3


You are an FY2 doctor in a GP surgery. Your next patient is Mr Smith who has returned to the surgery for results of his PSA test. Unfortunately, the laboratory has lost the sample, and you are required to inform Mr Smith of this.



You are Mr Smith, a 45 year old gentleman who has returned to the GP surgery for the results of your recent PSA (Prostate) test. You are extremely upset to discover that the sample has been lost, and would like to find out who is to blame and how they can be held to account. You are aggressive and confrontational. On further probing, you acknowledge that you have a significant phobia of needles, as they remind you of your past as an IVDU (intravenous drug user).

You are generally very anxious and worried about the possible diagnosis of prostate cancer, especially as your younger brother passed away with prostate cancer last year. The symptoms are becoming increasingly troublesome, waking you at night regularly and making you very tired during the day. At home, you live with your wife who is very supportive as are your work (plumber), although you are worried that if you keep on having to miss work for medical appointments, their patience will soon run out.



Effective management of this consultation involves appeasing an upset and confrontational patient in challenging circumstances. The key to this is recognising that an error has been made as well as addressing Mr Smith’s underlying concerns (needles, urinary frequency and family patience). Appropriate solutions include suggesting/offering Mr Smith the following options:

1) Agree to further look into the whereabouts of the blood test sample and thus explore whether it is possible to avoid a further blood test.
2) Conduct an audit into the number of blood tests being lost, in order to prevent similar experiences for other patients.
3) Provide a suitable medical letter which can be used by Mr Smith to obtain time away from work to attend medical appointments.
4) After a further search, should the blood sample still not be locatable, to arrange a convenient time in the near future to repeat the test, and avoid additional delay.
5) Discuss with GP supervisor, the appropriateness of commencing Mr Smith on appropriate medication (eg. Tamsulosin) to manage his troublesome symptoms.
6) Offer Mr Smith the opportunity to arrange a follow-up appointment to address any further concerns as well as ensure all existing issues are being addressed.


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