Actors Instructions – Charlotte – (Grace Baxter sim)

You are an 18 year old woman who is 14 weeks pregnant (unplanned). This is your
first pregnancy. You have a month’s history of fatigue and are attending your GP to
ask for a note for your college to send to the examination board as you have A Level
examinations in a week’s time, so that this extenuating circumstance may be taken
into account regards the grade awarded.

If the doctor asks, you are not depressed but you are low in mood and have poor
concentration. You have not been sleeping well for the past fortnight. You are
worried about the future. You have no suicidal risk. You have no new urinary
symptoms.

If asked, you do not smoke; you do not drink alcohol and have never used recreational
drugs.

Your partner, who lives nearby in a single bedroomed flat at the private boarding
school where he teaches, was initially supportive of the pregnancy but now seems less
interested in you and the baby. He is 28 and not married and is unwilling to commit.
He has never been physically, emotionally or sexually abusive towards you.

You live with your parents and younger brother. Your parents are disapproving and
do not think you should have continued with the pregnancy. They had high hopes for
you going onto study engineering at university.

You have a close circle of friends from school but they are all going to university and
you feel left out.

If asked, you are upto date with antenatal care and you scan at 11 weeks was normal
regards dates and singleton foetus and Downs/Edwards/Patau screening. You have
been told that all your booking and screening blood tests are normal. No vaginal
bleeding and the baby is active. No abdominal pain. You have not yet attended
antenatal classes. You last saw your midwife four weeks ago.

You are on no regular medications and have no drug allergies. You have no relevant
past medical history.

You hope to be reassured about your symptoms, and to be given a note for the exam
board. You would be willing to accept a referral to the pregnancy support
services/counselling/women’s centre/Self help apps. Not sure how your partner would
take to an offer of going to RELATE,

If offered medication by the doctor you would not be keen in light of worries of it
harming your baby
Examination Findings

Looks well
Not clinically anaemic
BP 120/80
Uterus size compatible with dates
Urine – no blood, no protein, no glucose, no nitrites or leucocytes
Doctor’s Instructions

Charlotte is an 18 year old lady who is 14 weeks pregnant. You have not seen her
before. You note from the midwife’s consultations that her pregnancy is progressing
normally.

There is no relevant past medical history and she is on no regular medications.

CSA Case Marking Sheet
Case Name: Charlotte (18 YR OLD) Centre: CRH Scheme name: Pennine
GP ST Name: CSA Surgery Date:

DATA GATHERING, TECHNICAL AND ASSESSMENT SKILLS

Positive Descriptors Negative Descriptors
Explores reasons for attendance Focuses on depression to exclusion of
social history

Assesses mood/depression Poor attempt at excluding red flags

Explores red flags e.g. suicide risk, Does not include antenatal history
domestic violence, alcohol excess, drugs.
Explores relationship with partner Does not ask about support networks
Explores home situation/education
Explores support networks e.g. friends
Checks antenatal care up to date
Examines patient – BP, signs of anaemia,
urine dip test

CLINICAL MANAGEMENT SKILLS

Positive Descriptors Negative Descriptors
Provides reassurance that fatigue is Dismisses patient’s concerns, does not
normal in pregnancy and often improves consider psychosocial causes of fatigue
in the second trimester and acknowledges
different social stressors
Arranges a letter for the examination Inappropriate management e.g. prescribes
board. Arranges FBC anti-depressants, refers to antenatal clinic
Offers follow up in approximately two No note provided to patient, no offer of
weeks time – safety nets appropriately follow up
Makes patient aware of other support
available/offers referral e.g. women’s
centre/counselling/Midwife/Relate and
specific local support services for
pregnant women

INTERPERSONAL SKILLS
Positive Descriptors
Empathic
Allows patient to tell their own story –
golden minute
Facilitates history by active listening and
appropriate body language
Clarifies history by summarising back to
the patient
Respects confidentiality where
appropriate – asks permission to refer to
other healthcare professionals
Shared management plan
Negative Descriptors
Judgemental and/or dismissive of
patient’s concerns
Early interruption
Early use of closed questions and/or
defensive body language
Fails to summarise during history taking
Fails to respect confidentiality – assumes
consent for referral
Paternalistic/doctor-centred approach