PCC-Scenario 1 simulated patient script

Patient’s Name Ian/Jan Walker Course BBN

Setting out-patient clinic Session ACH
case 1
Age 60+
Gender M/F

You are a 60-year-old social worker living with Alex.

Past You have a six-week history of indigestion and more recently, some loss of
appetite, heartburn, and soreness on swallowing.

You have begun to lose a few pounds in weight. You went to your GP a week after it
started as you had never had indigestion before. The GP prescribed omeprazole.

A week later you were worse so returned to your GP and they arranged a camera
test. As well as the camera test, you had a biopsy and tests for a special germ
associated with stomach ulcers.

Your mother had a hiatus hernia. At worst you think it is a stomach ulcer and that
you will need tablets. You would be apprehensive about surgery but you understand
that surgery is an old-fashioned treatment for stomach ulcers.

Now You had your tests last week and have come back for your results.

Ideas, Concerns, Expectations

You wonder if you might have a hiatus hernia like your mum. She ended up having
surgery so that is a concern for you
The Dr who took the biopsies mentioned the C word but you don’t think that is
likely. You think that was just routine

Simulated patient additional points

Build up a social picture. You have no children. What are your hobbies?
Your partner is a librarian
You are looking forward to your holiday in the USA in three weeks. You want to
know if you can still go
You have never been ill in your life
How would you feel with these symptoms? How do you feel coming for the results?

Questions to ask after the diagnosis

What happens now?

Am I going to live?
What treatment will I have?
Scenario 2 simulated patient script

Your Name Jean/James O’Brien Course BBN

Setting Emergency Session ACH
assessment unit case 2
(hospital)
Age 60 +
Gender M/F

You are a 70-year-old man/woman who has had Parkinson’s disease for 8 years. You
have become increasingly unsteady on your feet in the last 2 years and fall regularly.
This is despite regular reviews by your Parkinson’s disease team.
You live alone as your wife/husband sadly died last year – he/she used to help you
get up off the floor when you fell. You need a zimmer frame to help you to walk.
You have been admitted with another fall – your legs just gave way when you were
walking with your frame. You fell onto your right side and landed on your wrist,
which was very painful. You called an ambulance that brought you to A+E.

In A+E you have had an x-ray that showed you have broken your right wrist. The
doctors have told you that it doesn’t need an operation but will need to be in a cast
for 6 weeks. You have since seen a physiotherapist and managed to walk with them
helping you. They have told you that you cannot use a frame as you can’t put weight
through your wrist until it has healed.

Your wrist is a little sore but the painkiller tablets help a lot with this. You are
desperate to go home. You have a cat that needs looking after. Your daughter lives
50 miles away but is coming to the hospital this evening. The doctor has come to
speak to you about the plan from here. You are worried that if you don’t go home
now you will end up in an ‘old folks’ home’ like some of your friends and you do not
want that to happen.

Simulated patient additional information and tasks

The doctor should explain to you that the joint opinion of the staff is that it is not
safe for you to go home as you can’t walk by yourself. They will recommend that you
have a period of rehabilitation until your wrist heals. When the doctor mentions that
it is not safe for you to go home you should initially be upset and resistant to this
idea. If asked, you can explain your fears about ending up in a care home. You could
say that it is your decision to make and no-one can force you to do anything that you
don’t want to do (the student should say that it is indeed your choice and they are
providing you with information to make an informed choice.
You should also be worried about what will happen to your cat. If the student asks
about this further, you suggest that your daughter could look after the cat.
If you feel that the student has explored your concerns and provided reassurances
you will agree that the best course of action is to go for a period of rehabilitation. If
not, you should say that you are not making any decisions until you speak to your
daughter.
Scenario 3 simulated patient script)

Your Name George/ Course BBN

Georgina Martin
Setting Hospital outpatient Session ACH
Clinic
Patient Your mother Mrs. case 3
Edith Martin
Age Up to 60
Gender M/F

Hospital outpatient clinic - you ask to speak to the doctor whilst mother is having
blood taken

Your mother Edith lives alone. She is fairly well - her arthritis has slowed her down a
bit, but she still cooks and shops for herself. She has mild dementia but remains
mostly independent and looks after herself. She does not drive so you have brought
her to the hospital today for an out-patient appointment. You are very fond of your
mother and wanted to bring her to the clinic. You run your own business i.e. you are
self-employed.

She found a breast lump (you haven't seen it) and her GP suggested that she saw the
breast specialist. She had tests done one week ago - a mammogram and a biopsy.
The mammogram showed a suspicious area. You have come for the biopsy results.
You ask to see the clinic doctor in the hospital before he/she sees your mother.

You are convinced that she has breast cancer and think that she wouldn't cope with
knowing this and would give up. You do not want the doctor to tell her it is cancer.
You have asked to see the doctor whilst your mother is having some blood tests.

Ideas, concerns, feelings, and expectations

Whilst your mum has dementia, it does not affect her greatly at present. She
occasionally forgets people’s names but is fully able to make decisions for herself.
You should make this clear to the student if they ask

Why won't mum cope if it is cancer? List two or three reasons for this belief – a
main one should be because it will make her worry a lot and that she would ‘give up’

Although you don’t want mum told, you must be prepared to compromise with the
doctor/student after you have tried to get your way, especially if you feel that some
treatment might make your mum feel better

Suggestions re feedback to the student after the interview:

- Did you get ‘fobbed off’ or were your concerns acknowledged and addressed
- Did the student negotiate options for a solution to the dilemma?
- Were they summarised and the next steps discussed and agreed with you?
 - Scenario 4 simulated patient script
-
Your Name John/ Jane Course BBN
Rodgers
Setting Older persons’ Session ACH
ward
Patient Your father: Mr. case 4
Albert Rodgers
Age Up to 60
Gender M/F
-
- Hospital ward – your father was admitted yesterday with pneumonia and is
very unwell
- Your father, Albert Rodgers, was admitted to hospital yesterday from his care
home. He has been increasingly frail and unwell over the last 3 years. He has
lived with dementia for 5 years and this has been slowly getting worse. He
also has COPD that affects his breathing. Last year he was very unwell and
was in hospital for a few weeks with pneumonia. Afterwards, he was much
more frail and unable to walk. His dementia significantly deteriorated and he
moved into a care home. Over the last year he has slowly deteriorated. He
has: been losing weight, become more confused and less mobile. He now
needs assistance with his meals and drinking. He is unable to communicate or
discuss any of his needs. You have a lasting power of attorney for health and
welfare, which means you are legally allowed to make decisions on your
father’s behalf.
- 2 days ago, your dad became more unwell in the care home. He was started
on some antibiotics but he deteriorated and was rushed to hospital today.
The team in A+E told you he was very unwell but they started treatment with
some antibiotics. He has now been transferred to the ward. He looks even
more unwell and you think that he might die. The nurses have told you that
he is very poorly and the doctor wants to speak to you about his treatment.
- The doctor is going to speak to you about resuscitation. You have a vague
idea what this means as you have seen it on television programmes. You
should initially be angry that this has been mentioned as you feel they are
giving up on your dad. You do know that your father is very unwell and you
do not want him to suffer. You feel that he has had a terrible life over the last
2 years and that he would not want to live as he is now.
- Simulated relative additional points
- You should be clear with the doctor that your father has been slowly
deteriorating for the last year
- You know that he is very unwell now with pneumonia
- If the doctor explains to you in a sensitive manner the reason for the ‘do not
resuscitate’ order then you will agree to it. If not, you should remain angry
that they are giving up on your dad.