mymrcgp ©

Case 3

 

 

Candidate Information:

 

Ronald Simpson, Age 60

Significant Past History: Type 2 Diabetes Mellitus, COPD

Current Medication: Metformin, Gliclazide, Aspirin, Simvastatin, Seretide, Salbutmol

Recent Investigation Results: TSH 3.0, HBA1c 7.4, FBC no abnormality, U&E no abnormality, LFT no abnormality

 

 

 

 

Actor Instructions:

 

You are Ronald Simpson, a 60 year widower. You feel suicidal and have come today to ask for some sleeping tablets. You plan to commit suicide by taking these with a bottle of sherry.

 

 

Information freely divulged

You have not been sleeping well for the last 6 months and open with the statement ' I wonder if you could give me some sleeping tablets'. You have tried some tablets from the chemist such as Nytol and Kalms but nothing seems to work. You have also been trying to read or have a glass of sherry before bed to help you doze off. You feel desperate to get a good nights sleep. 

 

 

Information divulged if asked

  • You go to sleep about 11pm but then wake at about 3 am and then cannot get back off to sleep. You do not sleep during the day.

  • You lost your wife 1 year ago to breast cancer, and miss her terribly.

  • You live alone, and have one daughter but she lives in Australia.

  • You do the housework and garden yourself but over the past couple of months you cant be bothered with it.

  • You cannot work because of your COPD but your finances are adeaquate to cover your living costs. You used to work as a builder, you feel useless because you cant work anymore. You feel you’re ‘no good for anything’.

  • You have lost your appetite and your clothes have got loose so you think you’ve lost weight.

  • You can’t seem to concentrate on reading the paper or watching tv anymore.

  • You used to meet your friends at the snooker club each week but you haven’t been bothered for months now.

  • You drink a small glass of sherry each night

  • You do not smoke anymore.

 

You reluctantly divulge the following information if the doctor specifically requests it and you feel the doctor is being empathetic and you have a good rapport

 

  • You have been having suicidal thoughts

  • You have not made any attempts to harm yourself but have been thinking about taking tablets.

  • You were coming today to get some sleeping tablets so you could take them all with a bottle of sherry, you feel like you’ve just had enough and want to end it all.

 

When the doctor suggests you see the psychiatry team today you agree as you say you realise you need some help.

 

CSA Cases