{"id":2688,"date":"2022-03-02T18:29:52","date_gmt":"2022-03-02T18:29:52","guid":{"rendered":"https:\/\/gp-training.hee.nhs.uk\/bolton\/?page_id=2688"},"modified":"2022-07-26T21:25:21","modified_gmt":"2022-07-26T20:25:21","slug":"case-5","status":"publish","type":"page","link":"https:\/\/gp-training.hee.nhs.uk\/bolton\/mrcgp-examinations\/rca-calibration-tool\/case-list\/case-5\/","title":{"rendered":"Case 5"},"content":{"rendered":"\n<a href=\"https:\/\/gp-training.hee.nhs.uk\/bolton\/mrcgp-examinations\/rca-calibration-tool\/case-list\/\" class=\"wp-block-nhsblocks-nhsbutton nhsuk-button\">Back to Case List<\/a>\n\n\n\n<p class=\"has-text-align-center has-white-color has-emergency-red-background-color has-text-color has-background\" style=\"font-style:normal;font-weight:700\">Remember, before reading the analysis, ensure you have listened to the recording, made your own notes and completed your own assessment of the case.<\/p>\n\n\n\n<p>This video recording looks at a patient who presents with depression.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-vimeo wp-block-embed-vimeo wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Case 5 - Depression\" src=\"https:\/\/player.vimeo.com\/video\/672319400?dnt=1&amp;app_id=122963\" width=\"640\" height=\"360\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture; clipboard-write\"><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"has-white-color has-nhs-blue-background-color has-text-color has-background wp-block-heading\" style=\"font-style:normal;font-weight:700\">Analysis<\/h2>\n\n\n\n<p class=\"has-text-align-center has-white-color has-emergency-red-background-color has-text-color has-background\"><strong>It is important to note that the expert analysis is to be used as a guide only. These cases have not gone through the same rigorous approach used in the marking of the real RCA examination. However, the analyses provide an indication of how a typical assessor might review and grade a case.<\/strong><\/p>\n\n\n\n<h3 class=\"has-nhs-blue-color has-text-color wp-block-heading\">Summary<\/h3>\n\n\n\n<p>Overall, quite a superficial history, with serveral opportunities to follow-upon cues missed or ignored, culminating in a management plan that is not very patient-centred.<\/p>\n\n\n\n<h3 class=\"has-nhs-blue-color has-text-color wp-block-heading\">Timeline<\/h3>\n\n\n\n<p>0.10 Patient volunteers feeling flat and doctor asks at 22 seconds how is mood patient says bit down<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>The doctor must mentally think depression and rather than an open question \u201ctell me more\u201d goes on to ask<\/em><\/p>\n\n\n\n<p>0.32 open question re sleep<\/p>\n\n\n\n<p>1.10 closed question re \u201clast time had fun\u201d<\/p>\n\n\n\n<p>1.35 open question what else has changed immediately shut down with three combined closed questions re eating drinking appetite<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>The golden minute is lost with the early interruption. The doctor falls into the trap of qualifying open with closed questions and asking multiple questions together<\/em><\/p>\n\n\n\n<p>1.55 Two closed questions combined re tiredness and energy levels Patient says impacting on work and needs to get sorted : both cues ignored The Doctor asks if anxious which patient says no panic attacks or worries<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>More combined closed questions and missed cues re work<\/em><\/p>\n\n\n\n<p>2.25 Doctor says tell me more about home life 28 lives parents mum is also worried another missed cue (why is mum worried?). You mentioned about work what do you do says doctor (again opportunity to use cue about how affecting work missed) Doctor ploughs on with psychosocial do you smoke or drink.<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>More missed cues re work and mothers concerns. Robotic asking of job smoking alcohol rather than how is this affecting your life. People who feel like this can drink a little more\u2026.<\/em><\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>The doctor has explored symptoms of depression but hasn\u2019t tried to uncover any precipitating causes eg work home life events nor any potential physical causes eg hypothyroidism<\/em><\/p>\n\n\n\n<p>3.23 Doctor questions re illicit drugs<\/p>\n\n\n\n<p>3.37 Doctor checks not already on medicines and has no other medical problems<\/p>\n\n\n\n<p>4.00 Doctor asks if any dark thoughts re harming self, patient says thoughts but no intent and Doctor says parents protective<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Done ok his safety is established<\/em><\/p>\n\n\n\n<p>4.40 Doctor asks for patients\u2019 thoughts about what is going on Patient says probably depressed and that his mum thought same and should get help<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>The opportunity to follow the narrative cues and into expectation (Did your mum have anything in mind?) is missed, as Doctor asks about Concerns in a formulaic way<\/em><\/p>\n\n\n\n<p>5.03 Patient says doesn\u2019t want to feel like this brings up affecting work again<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Cue ignored<\/em><\/p>\n\n\n\n<p>5.20 Expectation asked and patient asks if tablets needed<\/p>\n\n\n\n<p>5.32 Doctor says good suggestion and goes on to use technical explanation of neurotransmitters and how sertraline will help with list potential side effects this lasts 61 seconds<\/p>\n\n\n\n<p>6.33 Patient asks if addictive (doctor doesn\u2019t ask why asks) says no.<\/p>\n\n\n\n<p>6.55 Doctor asks if ok patient says doesn\u2019t want anything addictive that will affect mind (again cue not followed)<\/p>\n\n\n\n<p>7.20 Patient asks how long on for. Doctor explains check in 4 w and then up to 6m treatment<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>It feels that the doctor is simply being led by the patient I\u2019d like tablets ok here they are<\/em><\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>No overview is given eg people who find themselves in your situation can benefit from tablets for mood like you say and this is sometimes combined with talking therapies \u2026 then a discussion of pros and cons.. then what do you think would be best for you?<\/em><\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Instead this sounded like a lecture everything I know about neurotransmitters The patient had to ask for information rather than the doctor outlining course of treatment and or asking what else the patient wanted to know<\/em><\/p>\n\n\n\n<p>8.05 Asks patient for thoughts on that and patient says something should do<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\">Once again this isn\u2019t true negotiation saying &#8220;is that ok?&#8221; and &#8220;glad we\u2019ve come to agreement&#8221; isn\u2019t negotiation. Giving pros and cons and patient deciding is. It&#8217;s ok to weight the choices eg normally the first thing we would do in your situation is or \u201cthe advantages of doing this first would be\u201d.<\/p>\n\n\n\n<p>8.15 follow up arranged<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Follow up is arranged but no safety netting ie if you were to feel worse what would you do\u2026? and potentially give crisis numbers etc<\/em><\/p>\n\n\n\n<p>8.38 End<\/p>\n\n\n\n<h2 class=\"has-white-color has-nhs-blue-background-color has-text-color has-background wp-block-heading\" style=\"font-style:normal;font-weight:600\">RCA Assessment <\/h2>\n\n\n\n<p class=\"has-text-align-center has-white-color has-nhs-grey-dark-background-color has-text-color has-background\">RCA assessment Overall: <strong>Clear Fail<\/strong><\/p>\n\n\n\n<p class=\"has-white-color has-emergency-red-background-color has-text-color has-background\">Data Gathering: <strong>Fail<\/strong><\/p>\n\n\n\n<p>The history is limited to symptoms of depression and other than questions about alcohol and drugs other causes both psychological and physical are missed He asks about work but not the effect on work Safety is just about established<\/p>\n\n\n\n<p class=\"has-white-color has-nhs-grey-dark-background-color has-text-color has-background\">Management: <strong>Clear Fail<\/strong><\/p>\n\n\n\n<p>The patient asked for antidepressants and got them. The doctor didn\u2019t outline alternative treatments nor the pros and cons of those approaches. The follow up didn\u2019t include what to do if things got worse.<\/p>\n\n\n\n<p class=\"has-white-color has-nhs-grey-dark-background-color has-text-color has-background\">Interpersonal:<strong> Clear Fail<\/strong><\/p>\n\n\n\n<p>The doctor didn\u2019t seem interested in finding out about the patients\u2019 life. Once the decision to prescribe was made a physiology lecture was given which almost certainly went over the patients head The examiner knows that information and doesn\u2019t need to be told it. Information about follow up and side effects and duration had to be asked for by the patient. The patient wasn\u2019t involved in making a management plan<\/p>\n\n\n\n<div data-wp-interactive=\"core\/file\" class=\"wp-block-file\"><object data-wp-bind--hidden=\"!state.hasPdfPreview\" hidden class=\"wp-block-file__embed\" data=\"https:\/\/gp-training.hee.nhs.uk\/bolton\/wp-content\/uploads\/sites\/52\/2022\/03\/Case-5-Depression.pdf\" type=\"application\/pdf\" style=\"width:100%;height:600px\" aria-label=\"Embed of Embed of Case-5-Depression..\"><\/object><a id=\"wp-block-file--media-955e0f02-5e28-4dd8-a9d7-42f79295da96\" href=\"https:\/\/gp-training.hee.nhs.uk\/bolton\/wp-content\/uploads\/sites\/52\/2022\/03\/Case-5-Depression.pdf\">Case-5-Depression<\/a><a href=\"https:\/\/gp-training.hee.nhs.uk\/bolton\/wp-content\/uploads\/sites\/52\/2022\/03\/Case-5-Depression.pdf\" class=\"wp-block-file__button\" download aria-describedby=\"wp-block-file--media-955e0f02-5e28-4dd8-a9d7-42f79295da96\">Download PDF<\/a><\/div>\n\n\n\n<a href=\"https:\/\/gp-training.hee.nhs.uk\/bolton\/mrcgp-examinations\/rca-calibration-tool\/case-list\/\" class=\"wp-block-nhsblocks-nhsbutton nhsuk-button\">Back to Case List<\/a>\n","protected":false},"excerpt":{"rendered":"<p class=\"nhsuk-card__description\">Remember, before reading the analysis, ensure you have listened to the recording, made your own notes and completed your own [&hellip;]<\/p>\n","protected":false},"author":107,"featured_media":0,"parent":2724,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-2688","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.0 - 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