Confirms Patient S Name and Age

29 Diarrhoea

Checklist / P / MP / F /
Appropriate introduction
Confirms patient’s name and age
Explains reason for consultation
Obtains consent
Open question to elicit presenting complaint
Allows patient to open up, listens carefully, remains silent and does not interrupt the patient
Signposts: e.g. ‘Mr Gregory, thank you for telling me about this problem. I would like to ask a few more detailed questions. Is that all right?’
History of presenting complaint
• Clarify what the patient means by diarrhoea in their own words
• Onset (how it started)
• Character:
• Consistency:
• Watery
• Loose
• Greasy and difficult to flush away
• Well formed
• Mucus
• Colour:
• Black (melaena)
• Red (blood)
• Green
• Smell: offensive
• Pellets
• Time:
• Duration
• Intermittent, continuous, progressive
• Frequency
• Volume (more or less than usual)
• Alleviating factors: dietary factors
• Exacerbating factors:
• Dietary factors
• Gluten-containing foods (coeliac disease)
• Severity
• Asks if patient is suffering from any other symptoms
• Asks about any recent illnesses
• Previous episodes of diarrhoea
• Family members/contacts with similar symptoms
Asks about other gastrointestinal/colorectal and other relevant symptoms:
• Nausea/vomiting
• Bloating
• Abdominal pain: is it reduced with defecation?
• Abdominal swelling
• Anal pain
• Constipation
• Tenesmus
• Faecal incontinence
• Fevers
• Symptoms of IBS:
• Constipation
• Psychosocial stressors
• Flatulence
• Symptoms of anaemia:
• Lethargy
• Shortness of breath
• Dizziness → postural
• Symptoms of malabsorption: generalised weakness/lethargy
• Symptoms of IBD:
• Blood
• Arthralgia
• Back pain (sacroiliitis)
• Oral ulcers
• Skin problems
• Pyoderma gangrenosum
• Erythema nodosum
• Eye pain
• Risk factors for Clostridium difficile:
• Recent hospital admissions
• Recent antibiotic courses
‘Red flags’:
• Rectal bleeding:
• Mixed with stool
• Around stool
• Dripping from rectum, separate from stool
• Black stools (melaena)
• Weight loss
• Loss of appetite
Review of systems:
• Gynaecological symptoms: related to ovarian cancer
Past medical history:
• Any bowel disorders
• Diabetes (for autonomic neuropathy)
• Radiotherapy (for radiation colitis)
• Previous abdominal/intestinal surgery
Family history:
• Colon cancer
• IBD (Crohn’s disease, ulcerative colitis)
• Coeliac disease
Drug history:
• Laxatives
• Metformin
• Iron tablets
• Antibiotics (e.g. erythromycin)
• Thyroxine
• Over-the-counter medication
Allergies
Social history:
• Recent foreign travel/foreign contacts
• Similar symptoms in other members of travelling party
• Accommodation
• Rural/forest exposure
• Water consumed (mineral water, tap water, boiled water)
• Diet:
• Recent changes
• Takeaways
• Barbecues
• Contact with anyone suffering from diarrhoea
• Smoking
• Alcohol
• Occupation (dusty environment)
• Accommodation: institution, residential home
• Activities of daily living
Use of non-verbal cues, e.g. good eye contact, nodding head and good body posture
Systematic approach
Explores and responds to ICE:
• Ideas
• Concerns
• Expectations
Shows empathy
Non-verbal skills
Avoids technical jargon
Devises holistic management plan and addresses psychosocial issues as well as medical problems
Summarises
Offers to answer any questions
Thanks patient

OSCEs for Medical Finals, First Edition. Hamed Khan, Iqbal Khan, Akhil Gupta, Nazmul Hussain, and Sathiji Nageshwaran.