GPST/Candidate

Lisa Walker

30 year old Shop worker

Past medical history: Migraine, Non Smoker, 2 x NVD (2009, 2007) Sterilisation 2011

Last attendance April 2013 Coryzal symptoms, obs stable URTI Treat symptomatically.

Drug History No Current Repeat

NKDA

CSA Simulator Instructions

30 year old female 'Lisa Walker'

You have a history of migraines (one sided throbbing headaches with flashing lights and nausea lasting about 12 hours) , which you have suffered with for the past 6 years and have been well controlled with simple pain killers. Your last migraine was around 12 months ago. Over the past 1 month you have been suffering with new headaches. They come on slowly, and are a dull type pain, you get them a few times a week, like a band around your head. There isn’t anything that triggers the headache and you have no other symptoms.

Only if asked: Headache is light a tight band around your head, worse at the end of the day, no vomiting, no visual symptoms, not waking with headache, no clumsiness or unsteady gait, no muscle power weakness or altered sensation

You have used paracetamol 2 tabs qds about three times a week.

You have taken Kalms from the local herbalist to no avail

Nytol has not really helped you sleep better

At home you are married with two young children 8 and 9. You work full time in a mobile phone shop which has been particularly busy recently and your sales targets are forever increasing. Your boss is more interested in the sales than the staff. You have a good relationship with your husband.

You are very stressed at present. Your mood is low due to stress with at work. Your appetite and sleep are poor. You have no thoughts of self-harm or suicide.

You do not smoke.

You drink 14 units of alcohol a week

You do little exercise

You are worried about the headaches affecting your ability to work and take care of children. You don’t think it’s anything serious and don’t want further tests, hoping for reassurance. You were wondering what painkillers are best to take. If the doctor suggests that you are low in mood and stressed acknowledge this may be correct and possible cause/aggravating factor.

You cannot afford to have time off work

Examination findings

BP normal, no papilloedema, cranial nerve and PNS exam normal

CSA Case Marking Sheet

Case Name: Lisa Walker / Centre: click and enter scheme name
GP ST Name: click and enter gp st name / CSA Surgery Date: click and enter date
Case Title:Headache and Mental health problem
Context for the Case:
Ability to manage Headache and stress in primary care.
Developing and maintaining a relationship and a style of communication that treats the patient as an equal and does not patronise the patient.
Acquiring knowledge of the patient’s relevant context, including family, social and occupational factors.
Assessment Domain:
1.Data-gathering, technical and assessment skills
Positive descriptors:
SPICEexplored
Takes an appropriate headache history
Headache red flags detailed
Explores symptoms of stress and depression
Exclude suicide risk
Identifies psychosocial problem re work
What she already has tried
Appropriate physical examination / Negative descriptors:
SPICE not elicited
Incompleteheadache neurological history / red flags
Doesn’t explore possible depression or stress.
No examination or missed elements
Assessment Domain:
2.Clinical Management Skills
Positive descriptors:
Credible reassurance
Explanation of tension headache which makes sense of her symptoms and the management plan
Explanation of stress and tension headache
Management to include sleep hygiene, relaxation therapies, offers referral to stress management/counselling, on line options e.g. Mood Juice, offer of time off work, exercise, ? sedating antihistamine/amitriptyline at night, advises discussion of targets with boss. etc
Clear follow up and safety netting / Negative descriptors:
Fails to take account of related issues or co morbidity.
Unable to construct a problem list and prioritise.
Limited options
Options not shared with patient
Follow up arrangement are absent
No safety netting
Assessment Domain:
3. Interpersonal skills
Positive descriptors:
Maintains and establishes rapport
Uses aspects of SPICE in the last 1/3 of the consultation
Shows empathy with situation.
Shared decision making / Negative descriptors:
Doctor’s centred management.
Not empathetic.
SPICE not used
No shared decision making
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