Case 1


The Examiners Notes


The main issue in this case is the identification of the patient’s expectation 'I need an x-ray'. The issue should be addressed by exploring the patients ideas and concerns . Explanations should be well communicated avoiding jargon and addressing concerns with empathy whilst avoiding inappropriate investigation. 


Data Gathering (The examiner will look for the following points)

• Structured history taking (details of an appropriate focused history are given in the topic summary)
• What analgesia if any the patient is taking
• Red flags
• Social context (in this case his financial worries as he is self employed)
• Appropriate examination


Interpersonal skills (The examiner will look for the following points)

• Identifies ICE (ideas, concerns and expectations)
• Empathetic and understanding of the situation
• Explains medical terms in a language the patient understands
• Patient centred


Clinical Management (The examiner will look for the following points)

• Makes an appropriate diagnosis
• Offers appropriate analgesia (nb is drowsiness as acceptable side effect for this patient?)
• Shares management
• Addresses health understanding (ie better to mobilise)
• Offers treatment options- analgesia, heat, exercises, physio
• Does not request an X-ray and explains the reasons for not doing so
• Specifies follow up
• Safety nets
• Offers written information in the form of a patient information leaflet


Negative Indicators

• Missing red flags

• Offering inappropriate advice or management
• Not doing an appropriate examination
• Requesting an X-ray
• Failure to identify the hidden agenda (wanting an X-ray)
• Being rude/doctor centred/authoritarian

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CSA Cases