GP Stage 3 Simulated Consultation - Relative 9
You are an SHO in psychiatry looking after Mr Harold Johnson, who was admitted following a suicide attempt. Mr Johnson has given you permission to speak to his wife, although he has requested that you do not mention about the suicide attempt.
You are Mrs Alicia Johnson, wife of Mr Harold Johnson. You have rushed to hospital to see your husband who was urgently admitted for an unspecified medical deterioration. You are confused as to why Mr Johnson is on a mental health ward when it appears as though he has been physically assaulted. You demand to know who perpetrated this assault and how they can be held to account. You would also like your husband moved to the main hospital ‘away from the crazy people’ so that he can be looked after properly. Failure to provide you with further information regarding your husband’s admission increasingly frustrates you and makes you aggressive.
At home, you normally live with your husband who was recently made redundant after an investigation into financial misconduct. There is impending court action against your husband which is increasingly concerning you. Over the last few weeks, you have not been eating or sleeping well and have also taken a number of days off work due to stress. You have not sought any medical attention and are confused as to what support would be available. You are also having negative thoughts about yourself and have recently started to self-harm. You feel as though you have reached a point where your life may not be worth living.
This consultation highlights a number of challenges. The initial challenge as with many ‘relative consultations’ is the concept of confidentiality. It is made immediately clear that Mr Johnson would like his suicide attempt to remain confidential and thus this is imperative, despite Mrs Johnson’s persistence. Failure to maintain confidentiality will result in candidates being deemed unsuitable for GP training.
The subsequent challenge is exploring the wider social environment and concerns that Mrs Johnson has. This involves sensitive probing as well as an empathetic approach. As the consultation progresses, it becomes clear that Mrs Johnson transitions from the ‘relative’ to the ‘patient’. Safe candidates will probe regarding Mrs Johnson’s own mental health including self-harm and suicidal ideation; coming to the likely conclusion that Mrs Johnson does not appear to be safe to go home on her own today.