GP Stage 3 Simulated Consultation - Patient 5
Dr Davidson, your GP supervisor has asked you to see Mr Thomas, 66 who has a 3 month history of weight loss, PR bleeding and alternating bowel habit. Dr Davidson has asked you to speak to Mr Thomas about the likely need for a colonoscopy to further investigate his symptoms.
Nb. You are not expected to consent Mr Thomas for this procedure.
You are Mr Thomas, a 66 year old gentleman who saw Dr Davidson (one of the GP Partners) last week regarding your concerning bowel symptoms. You are initially upset to be speaking to a junior doctor, and demand to speak to a ‘real doctor’, unimpressed that your life is being used as a ‘teaching session’.
You are made more upset and confrontational by candidates who ignore your concerns, and proceed to discuss the need for a colonoscopy rather than addressing your underlying concerns and disappointment at not being able to see Dr Davidson.
On further probing, you reveal that your younger brother passed away from bowel cancer six months ago, and that this is a real concern of yours. You have three children all of whom are grown up and live independently, however at home you live with your wife and your deceased brother’s, 11 year old child. You are particularly worried of the impact on this child if you also pass away with bowel cancer.
This case tests a candidate’s ability to deal with conflicting priorities. The doctor’s initial interests will be in explaining the need and procedure for a colonoscopy, however good candidates will keep the consultation patient-centred, shifting emphasis onto addressing Mr Thomas’ concerns as well as trying to arrange for Dr Davidson to also be present in the consultation/future consultation. Excelling candidates will further explore Mr Thomas’s underlying social circumstances as well as offering suitable solutions and arranging appropriate follow-up.
Examples of agreeable solutions include arranging a further appointment with Dr Davidson to address any additional concerns, although not delaying the colonoscopy request given that this is potentially urgent. Additionally, offering emotional support and details regarding IAPT services that can assist with this (eg. Wellbeing Service) would be appropriate.