GP Stage 3 Simulated Consultation - Relative 6
You are an SHO on a geriatric ward and have been asked to speak to Mrs Alice Jones, the partner of Mr Thomas Jones, a long term ward patient with advanced dementia who has been slowly declining. Mr Jones is currently being managed for urosepsis, and has also had a stroke during this admission. It is unlikely that Mr Jones will be discharged in the next week, and it is likely that Mr Jones will require long term nursing care. You have briefly met Mrs Jones previously, and have found her to be a very pleasant relative who visits her husband almost daily.
You are Mrs Alice Jones, wife or Mr Thomas Jones. Your husband is presently an inpatient after suffering a stroke and is presently being managed for a severe urinary infection. Mr Jones has advanced dementia and you feel that it would now be best to discharge Mr Jones home at the earliest so that you can look after him appropriately. As a retired doctor, you feel suitable equipped and feel that your husband has only become more unwell since he was admitted to hospital three weeks ago.
Recently, you have also noticed a number of patients pass away on the ward and you have doubts about the current ward consultant, Dr Matthias. In particular, you noticed that the patient across your husband died suddenly with a lung clot (pulmonary emboli), and the patient was not even given heparin (blood thinning) injections or stockings during their admission which you deem neglectful. You would like to know further about this case to ascertain whether there was medical negligence and demand to see the medical records.
At home, you live in a two storey house on your own; there is no stair-lift or mobility aid. You are otherwise well, with no significant medical or mental health concerns.
There are a number of challenges to overcome in this consultation. Initially, recognising and relaying that Mr Jones’ medical and mobility circumstances have changed and that he would likely no longer be appropriate to be discharged home is important. Thereafter, understanding why Mrs Jones who has previously been very accommodating would like an immediate discharge is important, as well as agreeing appropriate further investigation into these concerns, without breaching patient confidentiality. Finally, ensuring that Mrs Jones’ personal health and safety is assured is essential in completing a comprehensive consultation.