Patient Instructions

Name of Patient:

Mr Carl Ling

Description of the patient & instructions to simulator:

Carl is a 56 year old businessman who runs a copywriting business (mainly creating content
for webpages) from home. He works in the mornings as he likes a good lunch with a bottle of
wine and enjoys a ‘siesta’ before walking over to the golf club for an evening meal and some
more drinks (another bottle of wine). He started drinking heavily after his wife died. Averages
two bottles of wine a day.

Sometimes he can be a bit shaky in the morning and may need a morning drink ‘just to settle
his stomach’ and his hands. It just helps to ‘get the creative juices flowing’. He has no history
of fits or hallucinations, as he has never stopped drinking. He does not feel guilty about
drinking and no-one has expressed concern about his drinking (but then no one is at home
and he has no relatives nearby)

He is a driver, but very infrequently, and only does so in the morning and never after alcohol.
No drink-drive convictions.

His wife died of breast cancer 5 years ago. His great companion is his dog ‘Scrap’ who is
well known at the golf club and will often have half a pint of beer in the evening! He has a son
who now lives in Australia.

Other from an episode of palpitations a few years ago he has no medical problems of note.

Over the last three days he has had really bad upper abdo pain which has kept him awake at
night. It goes through to his back and has been getting worse in the last twelve hours. He has
vomited x3 this morning (bile but no blood). No diarrhoea or constipation. No black tarry like
stools.

Opening statement – “It’s my stomach doc, I think I need some lansoprazole.”

Ideas – he has bad stomach pain? an ulcer.

Concerns – he might need some time off work when he has an important job to finish. Also,
very keen to avoid hospital as he worries what might happen if he stops drinking and who
would look after ‘Scrap’.

Expectations– some Lansoprazole which one of his friends recommended at the golf club
last night.

Smokes an occasional cigar.

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Doctor’s (GP ST) Instructions

Name & age of patient Mr Carl Ling age 56

Summary Card
PMH: Paroxysmal AF 2010
DH: None
Allergies: None
BP 145/82 in 2000
BMI 26 in 2010

Case Notes - Last few entries in records:

2018 - Paroxysmal AF 2010 – Hospital advised no action as no recurrence since Jan 2010, has been
discharged.

Bereavement (wife died) 2015 – Tele consult: Condolences shared, seem to be coping ok

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CSA EXAMINATION CARD

Patient Name: Mr Carl Ling

Examination findings:

Clammy and pale

Pox 95%
P115
BP 95/60
Temp 36
No Jaundice, no anaemia
Epigastric tenderness with guarding.

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CSA Case Marking Sheet
Case Name: Mr Carl Ling Centre: click
GP ST Name: click CSA Surgery Date: click
Case Title: click
Context for the Case:
 Diagnosis of suspected pancreatitis / Peptic Ulcer Disease
 Alcohol dependence
 Hospital admission required
Assessment Domain:
1. Data-gathering, technical and
assessment skills
Positive descriptors: Negative descriptors:
 Identifies ICEs  Ignores aspects of ICE
 Identifies alcohol dependence  Fails to appreciate alcohol dependence
 Examines the patient  Fails to examine the patient
 Identifies he is acutely unwell  Fails to appreciate how unwell the patient is
 Identifies he warrants hospital admission  Fails to appreciate admission is warranted
 Identifies barriers to admission  Fails to identify barriers to admission

Assessment Domain:
2. Clinical Management Skills
Positive descriptors: Negative descriptors:
 Explains the working diagnosis  Fails to explain the working diagnosis or
need for hospital admission
 Explains the need for hospital admission
and the potential consequences of  Does not deal with the patients ICE,
remaining at home especially concerns re dog care or
withdrawal symptoms
 Deals with ICE and barriers to admission
(specifically provides options for dog  Does not admit the patient
care – Friends at the golf club, Family,
 Does not arrange post discharge review or
Neighbours, Kennels etc. Also explains
discuss need to address alcohol
regards withdrawal avoidance
reduction in the future
management in hospital).
 Persuades the patient to accept admission
 Arranges post discharge review and
signpost future need to deal with alcohol
reduction

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Assessment Domain:
3. Interpersonal skills
Positive descriptors: Negative descriptors:
 Is interested in him as a person  Lack of rapport
 Establishes and maintains rapport.  Judgemental behaviour
 Shows empathy re wife’s death
 Non judgemental
 Takes a positive approach to his
management