GP Stage 3 Simulated Consultation - Relative 5
You are an SHO on an acute medical ward and Mrs Smith would like to speak to you about Mr Smith’s care. Mr Smith is due to be discharged later today after successful treatment for a lower respiratory tract infection.
You are Mrs Smith, wife of Mr Smith. Mr Smith has been admitted to hospital for treatment of a chest infection 12 days ago, and is due to be discharged home today. You are not happy that Mr Smith is being discharged and feel that the ‘NHS is cutting corners as always’ to ‘save money’ and ultimately, Mr Smith will be re-admitted a few days later, as has happened previously. You strongly feel that one further day of hospital admission would help significantly.
The multiple hospital admissions is straining your relationship with your husband, as well as placing financial strain on you at home. If further probed, in order to meet the financial demands of your rent and expenses, you have been renting out your spare room at home on an online website and do not want Mr Smith to find out about this. You now have a regular tenant who you have developed a good personal relationship with and would feel bad evicting him without any notice. However, you feel that if Mr Smith were to remain one more day in hospital this would help to alleviate all of these concerns.
You are disappointed in yourself for the measures that you have taken, and would like guarantees from the doctor that this information will not be shared with Mr Smith. Overall, your mood is generally low and you are drinking half to one bottle of wine per day. You are not on any regular medication and are otherwise healthy. You have three jobs working as a receptionist, secretary and occasionally in the local supermarket on weekends. In addition to Mr Smith being allowed to stay one additional night, you would also like some longer term assistance in relation to your finances, and are unsure as to who can offer this support.
What should be a simple discharge discussion becomes far more complicated. The initial challenge is appeasing an upset relative and accepting that there is a risk of readmission although equally, a prolonged hospital admission has risks of hospital acquired infections. Additional sensitive probing is required in order to ascertain additional concerns regarding home circumstances, which will not be disclosed to doctors who lack empathy and understanding. Failure to obtain this information will limit one’s ability to score highly on this station.
With regards to extending Mr Smith’s admission this is clearly a complex decision which has wider implications, and many doctors may choose to defer this decision to a subsequent meeting involving a senior medical and nursing colleague later that day. The final issue relates to Mrs Smith’s personal welfare and mental health; requesting or arranging for Mrs Smith to see her GP to explore this further would represent an appropriate solution.