RCA Calibration Tool: How to Use the Cases

Case 9

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Remember, before reading the analysis, ensure you have listened to the recording, made your own notes and completed your own assessment of the case.

This video recording looks at a patient who presents with back pain

Analysis

Summary

This is a simple case in that the differential is limited (i.e. the patient tells the doctor what is wrong and what he wants). Had it been dealt with at that level it wouldn’t have been a good case to submit. However, the doctor does ask questions around diagnosis without labouring the point and does empower the patient with management choices. Also note whilst short in time, it covered all the ground needed

Timeline

0.00 Introduces and checks identity

0.20 Doctor asks what going on and patient says hurt back laying some flags in garden at weekend

0.31 Doctor lightens mood by saying serves right for doing on own, and asks him to tell more about pain Patient says pop in back really sore next morning

1.10 Doctor asks about radiation patient says a little bit had before when worse. Some dialogue over previous events and that doctor has said slipped disc in past.

This feels easy but I think its because the doctor is following the narrative that he being told the information needed.

1.55 Doctor check numbness tingling, move legs, bowels and bladder.

Signposts as red flags which is something the patient remembers from last time. Odd to use that term but later on uses the term to create safety net.

2.34 Doctor checks if gardener which he isn’t

Good guess but wrong; allows patient to continue narrative and tell him what he does do

2.45 Doctor asks how back affecting. Patient says stiffens up when stops.

Good open question to find out effect on life.  Note no unnecessary “not met you before” nor incursion into alcohol and smoking which aren’t relevant

3.05 Doctor asks if same as in past and patient reiterates not as bad as in past and just needs some more co-codamol and another stronger pain killer.

3.40 Doctor suggests stronger pain killer is naproxen and whether patient knows side effects with regards to stomach, which he doesn’t. Doctor suggests taking with food and offers, which patient declines

4.50 Doctor discusses co-codamol and side effects mainly drowsy with regards to driving and gardening.

Good debate between the two over what patient wants; Doctor highlighting side effects

5.30 Patients asks if can still work

5.50 Doctor advises he take a break from gardening and says pulled muscle/slipped discs take a few weeks to settle

6.20 Doctor asks if thought about physiotherapy in view of recurrence, which patient doesn’t want. Doctor leaves as option on table.

I liked this section options with reasons and patient allowed to decide

6.40 Doctor summarises situation: prognosis better in 4-6 weeks, see me then if not ok, and earlier if one of red flag symptoms mentioned earlier

Really good summary prognosis is reassuring and the safety net appropriate for condition without being overegged

7.26 End

RCA Assessment

RCA assessment Overall: Clear Pass

Data Gathering: Pass

It’s the simplicity that keeps it at Pass Done well but limited differential and no examination offered (was it needed if not explain why or when you will examine eg if absolutely no better in 2w weeks or the sciatica is worse it might be worth seeing you to examine)

Management: Clear Pass

Patient says what he wanted and doctor facilitated that Also offered physio Created prognosis and safety net.

Interpersonal: Clear Pass

Good reflective questioning Doctor followed the narrative and patient agenda. Also negotiated well.

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