Patient Instructions

Name of Patient:

Mandy Jones

Description of the patient & instructions to simulator:

44 year old housewife, married with 2 children, both of whom have now left home.
Husband works away Monday to Friday as a builder. At the weekends, they are
arguing a lot, she is worried he will have an affair as she has reduced libido. She is a
part time receptionist for the local solicitor.

Her main complaint is being tired all the time and she was seen last week by a doctor
who arranged blood tests. She is not sleeping well, can be tearful at times, feeling
lonely, as her last child left home recently and her husband is usually away all week.
She has been doing less housework and husband has commented on this which
started a row. She has been feeling this way for the past 6 months.

No thoughts of self harm or suicide, no psychotic symptoms. Did have “baby blues”
after birth of first child 20 years ago.

Has been using a “nightcap” to help her sleep, if asked directly getting through a
small bottle of gin a week. Ex smoker of 20 years.

Used to play tennis regularly but in the last 6 months she has not.

Takes OTC multi vitamins, no other medications. No known drug allergies.

If good rapport develops with the doctor she will accept that she is depressed. She is
really not wanting to have medication and would prefer some kind of talking therapy.
If the doctor is sensitive she will be willing to try medication.

Opening statement “I have come for my blood test results” – having seen the Nurse
Practitioner last week who arranged some blood tests.

Ideas – she is feeling down and lonely

Concerns – impact on relationship

Expectations – anything which might help, not keen on tablets though

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Doctor’s (GP ST) Instructions

Name & age of patient Mandy Jones 44 year old female

Summary Card
PMH: Baby blues 20 years ago – resolved without medical treatment
DH: No repeat medications
Allergies: NKDA
BP 125/75 last week, BMI 24, Ex smoker

Case Notes - Last few entries in records:

7 months ago – viral URTI

1 week ago – TATT – not sleeping well, arrange bloods and see again with results
Blood results: FBC – normal, TSH – normal, ESR – normal, Hba1c - normal

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CSA EXAMINATION CARD

Patient Name: Mandy Jones 44

Examination findings: PHQ9 – score 12 all other examinations normal

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CSA Case Marking Sheet
Case Name: Mandy Jones Centre:
GP ST Name: CSA Surgery Date:
Case Title: Tired all the time
Context for the Case:
 44 year old house wife with “empty nest”, bloods all normal, irritable with husband and
frightened he will leave her. Has symptoms of depression and would be willing to accept this
and have some treatment if good rapport with Dr
Assessment Domain:
1. Data-gathering, technical and
assessment skills
Positive descriptors: Negative descriptors:
 Re-visits history  Focussed too much on blood results and does
not re-visit the history
 Social background explored
 No assessment of depression or risk
 SPICE explored
 Fails to make a diagnosis of depression
 Asking all questions for depression screen
including a risk assessment  Misses the increased alcohol intake
 Asking about alcohol  SPICE not explord
 Discover her preference for counselling over
medication

Assessment Domain:
2. Clinical Management Skills
Positive descriptors: Negative descriptors:
 Explanation of depression.  No explanation of depression
 Plenty of shared options which are explained  No explanation/spinning of options
Relate, decrease alcohol use, counselling,
 Limited option share.
medication, time, CBT, Mood gym or Mood
juice, exercise, diet etc.  Lack of safetynetting
 Review appointment made and explicit
safetynetting

Assessment Domain:
3. Interpersonal skills
Positive descriptors: Negative descriptors:
 Establishes rapport  Poor rapport
 Shows empathy  No empathy
 Uses SPICE in the consultation  No use of SPICE within the consultation
 Discover her preference for counselling over  Prescribe without offering alternatives
medication
 No shared decision making
 Shared decision making

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