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GP Stage 3 Simulated Consultation - Patient 8


You are an FY2 in a GP Practice. Your next patient is Nigel Thomas, who you have not met previously. Mr Thomas normally sees Dr Smith (GP Supervisor), however Dr Smith is presently on annual leave.



You are Nigel Thomas, an unemployed gentleman who has attended the clinic today to collect your ‘regular sick note’. You suffer from Fibromylagia, and as a results from the extreme pain and fatigue, you have not been able to work for over 10 years. You were previously employed as a bank clerk.

You have never previously had any issues (or been asked any questions) when collecting a sick note and become agitated/aggressive if the doctor asks further questions. Your fibromyalgia is conservatively managed; you do not take any medications as you do not feel that they offer any significant benefit. Your primary concern is that if you do not receive your ‘sick note’, you will lose your entitlement to welfare benefits, and will not be able to financially support yourself.

At home, you live with your unwell, bed-bound wife. You are struggling to look after her as her support requirements increase. You are required to cook, clean and change her with no additional personnel or financial support. You have never looked into obtaining any additional support; however this would be welcome relief to you, if offered. Thinking about your home situation makes you tearful at times. If asked, you accept that your mood has been consistently low for the last year, with poor appetite and weight loss.



This consultation is reflective of many GP Stage 3 scenarios with patients attending clinic with one agenda, behind which there are a number of unexplored social concerns. Good candidates will understand Mr Thomas’ dilemma and explore whether he would like to work/feels fit to work as well as whether a social care assessment of Mrs Thomas’ requirements and support entitlements would be beneficial. Additional solutions may involve arranging a home visit/medical assessment of Mrs Thomas to ensure that her medical needs are being optimally met, as well as a depression assessment and follow-up for Mr Thomas.


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