{"id":2711,"date":"2022-03-02T18:40:04","date_gmt":"2022-03-02T18:40:04","guid":{"rendered":"https:\/\/gp-training.hee.nhs.uk\/bolton\/?page_id=2711"},"modified":"2023-03-15T10:57:48","modified_gmt":"2023-03-15T10:57:48","slug":"case-12","status":"publish","type":"page","link":"https:\/\/gp-training.hee.nhs.uk\/bolton\/mrcgp-examinations\/rca-calibration-tool\/case-list\/case-12\/","title":{"rendered":"Case 12"},"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 audio recording is of a consultation regarding a patient who had requested further medication.<\/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 12 - Dyspepsia Medication Review\" src=\"https:\/\/player.vimeo.com\/video\/672327379?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>Cases for the RCA need to provide some challenge. On the whole they should be undifferentiated; i.e. not seen before single issue and provide some challenge. This consultation a review is an example of a type of case not to submit .There is no diagnostic or clinical challenge and the doctor potentially could have worried the patient with inaccurate explanations<\/p>\n\n\n\n<h3 class=\"has-nhs-blue-color has-text-color wp-block-heading\">Timeline<\/h3>\n\n\n\n<p>0.00 Doctor introduces himself and says understand wishes to discuss some medication.<\/p>\n\n\n\n<p>0.20 patient says needs medication review for lansoprazole. Has been on 5 years for reflux, initially higher dose had had some tests.<\/p>\n\n\n\n<p>0.58 Doctor asks about tests and patient had endoscopy a few years ago.<\/p>\n\n\n\n<p>1.37 Doctor asks what endoscopy showed and patient says lots of acid and negative helicobacter. Doctor says also showed hiatus hernia.<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>No new information has been obtained so far, The doctor is picking on cues (eg tests<\/em>).<\/p>\n\n\n\n<p>2.30 Doctor asks about how affecting day to day patient; patient says only if runs out of tablets or misses taking or after alcohol\/curry.<\/p>\n\n\n\n<p>3.05 Doctor asks if has altered diet as a result and patient says drinks less beer and may take 2 lansoprazole after curry.<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Superficially sounds good in that open question re effect on life, but the patient has already told us this and we are not seeing a new differential or information that will lead to a change in management<\/em>.<\/p>\n\n\n\n<p>4.35 Doctor asks about alcohol intake. Patient says now drinking less only Friday\/Saturday.<\/p>\n\n\n\n<p>5.10 Doctor delivers 14 units max alcohol lecture.<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Inappropariate. The patient is drinking within guidelines and has already reduced again no need for alcohol lecture and doesn\u2019t result in any change in situation<\/em>.<\/p>\n\n\n\n<p>5.31 Doctor asks if any other symptoms like problems with tummy. Patient says initial nausea. Regarding bowels &#8211; no change. Regarding stool &#8211; no black stools. Weight loss but because trying to.<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Reasonable assessment of potential red flags<\/em>.<\/p>\n\n\n\n<p>7.00 Doctor asks about home life. Patient says odd job man; stressful as not much work during pandemic, doctor says stress can make acid worse and patient says not stressed.<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Doctor is working hard to create a differential but it feels manufactured and unnecessary. It feels like this consultation would have been the &#8220;catch up&#8221; in a busy surgery&#8230; it\u2019s not one for the RCA<\/em>.<\/p>\n\n\n\n<p>7.45 Doctor asks if any worries and patient says no should he be, could he get addicted and Doctor says can come to that.<\/p>\n\n\n\n<p>8.22 Doctor asks if any expectations and patient says just my prescription.<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Clunky ICE doctor doesn\u2019t even answer question asked re addiction or what does the patient mean by that ?<\/em><\/p>\n\n\n\n<p>8.50 Doctor says doesn\u2019t sound like getting any side effects. Long term can thin bones, just wants to make aware, so may want to reduce at some point.<\/p>\n\n\n\n<p>9.28 Patient asks what needs to do. Doctor says in future may want to consider reducing, but sounds like still needs Also needs to make aware risk diarrhoea with Clostridium difficile. Patient not aware.<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Osteoporosis is a risk in those at risk \u2013 he isn\u2019t. Clostridium difficle is associated mainly in hospitalised patients so these are for him low risk serious complications which potentially could have worried him and stopped him taking the effective treatment . Poor information is worse than no information<\/em><\/p>\n\n\n\n<p>10.25 Doctor asks if concerned now, patien.t says no. Doctor says always safety nets, so if struggling sleep confused or anything abnormal get back to him<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Safety netting needs to be appropriate to the situation. Is one actually needed here? Maybe if it stops working or if you notice black stools but not a disaster safety net<\/em><\/p>\n\n\n\n<p>11.25 Indicates will be another review in 6 months<\/p>\n\n\n\n<p class=\"has-nhs-light-blue-background-color has-background\"><em>Why is a 6 month review needed? Why with a doctor ?<\/em><\/p>\n\n\n\n<p>11.42 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-pink-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>Hardly any new information is obtained. The past history is reviewed. There is no need to create a differential as the diagnosis is established. Job data is asked for as an aside rather than used. Current symptoms are reviewed however a pharmacist could have done the same review. Close to a Clear Fail.<\/p>\n\n\n\n<p class=\"has-white-color has-nhs-pink-background-color has-text-color has-background\">Management: <strong>Clear Fail<\/strong><\/p>\n\n\n\n<p>No new management. A repeat prescription and a lecture on alcohol for someone already drinking within recommended limits. An inappropriate safety net.<\/p>\n\n\n\n<p class=\"has-white-color has-nhs-pink-background-color has-text-color has-background\">Interpersonal: <strong>Clear Fail<\/strong><\/p>\n\n\n\n<p>The side effects described didn\u2019t relate to the patient and could have worried and stop him taking an effective medicine. ICE was clunky and almost irrelevant he just wanted a repeat prescription There was no empowerment of the patient.<\/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-12-Dyspepsia.pdf\" type=\"application\/pdf\" style=\"width:100%;height:600px\" aria-label=\"Embed of Case-12-Dyspepsia.\"><\/object><a id=\"wp-block-file--media-6c563e05-26c7-4ea9-b0b1-3c2d8dd3e4fa\" href=\"https:\/\/gp-training.hee.nhs.uk\/bolton\/wp-content\/uploads\/sites\/52\/2022\/03\/Case-12-Dyspepsia.pdf\">Case-12-Dyspepsia<\/a><a href=\"https:\/\/gp-training.hee.nhs.uk\/bolton\/wp-content\/uploads\/sites\/52\/2022\/03\/Case-12-Dyspepsia.pdf\" class=\"wp-block-file__button wp-element-button\" download aria-describedby=\"wp-block-file--media-6c563e05-26c7-4ea9-b0b1-3c2d8dd3e4fa\">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\n\n\n<p><\/p>\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-2711","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - 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