GP Stage 3 Simulated Consultation - Patient 9
Your next patient is Mrs Jenkins, who last came to the surgery 2 weeks ago to see Dr Matthews (GP Partner), for a re-prescription of Zopiclone (4 weeks prescription; to be taken once at night - equivalent to the maximum BNF dose). Mrs Jenkins does not have any other prescribed medications.
You are Mrs Jenkins, a retired solicitor who has come to the surgery today for a repeat prescription of Zopiclone. You normally see Dr Matthews (GP Partner) however he is on annual leave presently. You last saw him 2 weeks ago for your regular 4 week supply of Zopiclone.
Dr Matthews never asks any questions, and prescribes the medication routinely. For the last two months, you have been taking double the recommended dose on some nights as you are finding it particularly difficult to sleep. If asked, you also report that whilst you are not prescribed any other medication you occasionally also take some OTC (over-the-counter) sleeping pills as well, which you bought from the supermarket. You are not keen to discuss the matter, or your medication compliance, however if sensitively probed, you report that you are concerned about your husband’s health. He has recently been diagnosed with Malignant Melanoma (advanced skin cancer) and you are waiting to see the specialists about the prognosis and available management. Given that the doctor has asked, you are keen for the doctor to review the post excision biopsy report on your husband’s records and advise his likely prognosis and available management options.
You are unaware of the harm of taking excess medication, and did not have any self-harm/suicidal ideation/intention. You are keen to find a suitable sleeping tablet to assist you, as well as establish what support is available for you and your husband, given his new diagnosis.
Almost all candidates will recognise and address the fact that Mrs Jenkins is taking an unintentional overdose. The very best candidates will develop rapport in order to identify that Mrs Jenkins is taking additional non-prescribed medications as well as the social circumstances contributing to this.
It would be unprofessional and a breach of patient confidentiality to divulge information or provide advice regarding Mr Jenkins recent biopsy. Advising that this is best managed through tertiary care specialists as well as providing details regarding appropriate support groups (eg. Melanoma UK) would be the most suitable response.