GP Stage 3 Simulated Consultation - Patient 6
You are an SHO in a GP Surgery, completing your afternoon clinic. Unfortunately your clinic is running very late and the surgery reception staff are becoming increasingly frustrated. They have brought your next patient, Alex Jones directly to your consultation room to help reduce the delay.
Alex Jones has arranged to see you regarding the results of a recent CT Colonogrpahy:
Alternating bowel habit with PR bleeding. ? Bowel Ca (Refusing colonoscopy).
Two phased CT performed with multiplanar reformats. The liver is not enlarged. There are at least five hypodense nodules throughout the liver in segments 4 to 8. The lesions measure from 7mm to 5cm. The pancreas, spleen and both kidneys appear normal. There is an area of focal thickening and enhancement in the descending colon measure 4cm. A small number of mesenteric nodes are also visualised.
You are Alec Jones and have attended the GP Surgery today to discuss your ongoing cough, which has been present for more than 6 weeks. You have tried several different cough medicines to no avail, and have not had any formal investigations or tried any prescribed medications.
You are bemused and distressed by any candidates who report that you (may) have bowel/colon cancer considering that you have not previously had any investigations for this and were not aware that a cough may be a sign of bowel cancer.
On finding out that you have been mistaken for another patient you are extremely upset, and feel that the doctor is very unprofessional and careless.
With regards to your persistent cough, you are concerned that this may be a sign of lung cancer especially given your significant smoking history and the fact that your father was a smoker and also died of lung cancer. You have also seen NHS posters on the underground about how a cough for more than 3 weeks may suggest cancer. You would like the doctor to arrange appropriate investigations to hopefully exclude cancer. At home, you live with your partner and son who is due to get married next year. You are concerned that if it is cancer, you will not be able to attend your son’s wedding. With regards to employment, you work as a journalist and are keen not to miss too much work for further appointments and investigations.
This is a challenging consultation which highlights the importance of confirming a patient’s identity prior to commencing a consultation. Thereafter it is essential to offer a sincere apology where an error has been made (including when the matter is not directly one’s fault) and ensure that appropriate corrective and preventative measures are taken to prevent future recurrences.
In dealing with the patient’s actual concerns, a sensitive history is required exploring subtle concerns as well as including health promotion (smoking cessation) advice wherever possible. Whilst clinical knowledge is not formally assessed in GP Stage 3, it would be acceptable to exclude red flag symptoms of a cough (eg. haemoptysis & weight loss) as well as arranging a chest x-ray and follow up appointment.