Patient Instructions

Name of Patient:

Dr Sam Smith 49 years

Description of the patient & instructions to simulator:

GP in local Practice, married, no children, has been in the Practice for 20 years
A ‘new’ GP partner was appointed two years ago to replace lovely old Dr Jones who retired.
Initially he was fine but the new partner ‘George’ has become increasingly aggressive in
meetings, domineering and subverting any decision making with which he does not agree.
Prior to this it was a happy Practice but the other two female partners won’t stand up to
‘George’.

Sam has become increasingly stressed at work, he gets palpitations driving into work on the
days of Practice meetings. He is sleeping badly as he hates the environment at work.

His wife has complained that he is increasingly grumpy at home.

He was drinking a little too much in the evenings to help him sleep but 1 month ago realised
that ‘this was stupid’ and has stopped altogether. He has tried ‘Kalms’ which helped a bit and
he has tried over the counter chlorphenaramine which has failed to help him sleep. You have
not used other meds or drugs.

He still rides his bike three times a week as this helps clear his head.

He has not discussed the way he feels with the partners, as he feels George would not be
interested and Claire & Jo would be sympathetic but unable to do anything.

He comes today wanting something to help him sleep and perhaps some ‘betablockers’ to
stop his palpitations.

He is tired, low in mood regards his work situation, he has poor sleep but his appetite is
good, he enjoys non work activity, is not weepy and not suicidal – he is stressed and not
depressed.

Staff have complained about him being grumpy and he has had a few near misses with
prescription errors in the last 3 weeks

Would not accept local counselling as he would be seen by patients or known by counsellors.
You no nothing of the NHS Practitioner Health Scheme. Not keen on a sicknote/fit note
initially but might be persuaded

PMH – reflux DH – Lansoprazole 30mg a day

Stopped drinking alcohol a month ago. Non smoker

Ideas – He is stressed, Concerns – 6 years of this hell hole before I can retire,
Expectation – Betablockers and Promethazine tablets to help him sleep

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Doctor’s (GP ST) Instructions

Name & age of patient

Sam Smith

Summary Card
PMH:reflux
DH: Lansoprazole 30mg a day

Case Notes - Last few entries in records:

(2 years ago) – flare up in reflux after Sid Jones leaving do! Has run out of Lansoprazole. PPI double
for 1 week and rpts re-authorised

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CSA EXAMINATION CARD

Patient Name:

Examination findings:
All normal

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CSA Case Marking Sheet
Case Name: Stressed GP Case Title:
Context of case
 Stressed GP due to dysfunctional
partnership
Assessment Domain:
1. Data-gathering, technical and assessment skills
Positive descriptors: Negative descriptors:
 ICE explored  Fails to assess impact of work on home
 Causation explored  Fails to explore potential risks for patients
 Depression screened for  Fails to screen for depression
 Alcohol & drug history explored  Does not ask about drug or alcohol misuse
 Psychosocial impact explored
 Risks to patients explored
 Options already tried

Assessment Domain:
2. Clinical Management Skills
Positive descriptors: Negative descriptors:
 Congratulated on the positive and  Limited 'generic stress' options offered
professional things he has done
 Limited GP specific option offered
(stopping alcohol, exercise and seeing
you for help)  Fails to complete clinical management
section due to poor time management
 Regional NHS GP service for GPs (NHS
within consultation
Practitioner Health) discussed re what it
offers, self referral etc.  Failure of safety netting or no review
 Sick note offered for ‘time out’
 Occ Health referral offered
 Counselling offered via BMA services etc
 Support/advice from LMC
secretary/Chairperson
 Betablockers & promethazine offered
 Relaxation techniques suggested
 Discussion with other partners suggested
 Discussion with appraiser discussed
 Consideration re what might be the cause
of Georges change in personality
 Robust safety netting and review

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Assessment Domain:
3. Interpersonal skills
Positive descriptors: Negative descriptors:
 Empathetic with the situation  Seeming uncaring re situation
 ICE explored  Options listed but not discussed (lack of
shared management planning)
 Non judgemental
 Shared management planning