GP Stage 3 Simulated Consultation - Relative 10
You are an SHO in Trauma & Orthopaedics and Mrs Jones would like to speak to you about her son Thomas. Thomas is a 33 year old patient with learning disabilities who was admitted with a patella fracture after falling down the stairs. He is day 12 post-operative and is presently recovering well, although rehabilitation is proving difficult, given his moderate learning difficulties.
You are Mrs Jones, the mother of Thomas Jones and you have arranged a meeting with the doctor to discuss Thomas’ progress after his recent knee fracture and surgery. Thomas is your 33 year old son with learning disabilities who lives with you and your new partner, Edmond. Unfortunately, Edmond hit Thomas with a baseball bat and pushed him down the stairs after a disagreement about television. Edmond was drunk at the time and is a heavy drinker. To your knowledge, the hospital are not aware of the exact circumstances leading to admission, and you are keen for them not to find out. To this effect, you ask twice whether Thomas has mentioned anything to the doctors about how and why he was admitted to hospital. If asked further about the matter, you attempt to deflect and are not keen to discuss the exact circumstances leading to admission.
At home, you live with your violent and drunk new partner Edmond. Edmond has been physically and verbally aggressive to you and Thomas on a number of occasions, however since your husband left thirty years ago, you have felt very lonely and despite Edmond’s flaws, he is the first person to offer you any affection. You first met Edmond six months ago at a weekly session for people with learning disabilities, where Edmond helps out. You are keen not to disclose this information, although are prepared to discuss the abuse further with candidates probing sensitively.
You care full time for your son Thomas, and do not have any formal employment. At home, you do not have any additional support except Edmond. Your health is otherwise well, although you are worried if someone finds out about the events leading to admission, that you will be all alone once more. Since Edmond has moved in, you have also started drinking more and now drink almost daily.
The mention of a ‘suspicious fracture’ in a patient with learning disabilities should immediately raise safeguarding alarms amongst safe clinicians. This is compounded by Mrs Jones inconsistent personality and her focus on the history surrounding admission, rather than Thomas’ recovery. Good candidates will have a sensitive enough approach to establish the true circumstances surrounding admission as well as identifying the numerous risk factors at home. Excellent candidates will also note that Edmond not only represents a risk to Thomas and Mrs Jones, but also potentially to many other adults with learning disabilities due to his employment. There is unlikely to be one clear solution within the stipulated time frame to the numerous concerns, however arranging urgent further protective measures and meetings with a wider range of senior individuals will assist to safeguard Mrs Jones and other at risk individuals.