Transcript Problem Solving FOR CSA PREP

MOHAN KUMAR
SCENARIO 1
 Dave is 55 and soon to retire. He has been self
employed all his life and is selling his business to
enable him to take early retirement, as both his
children are now in full employment having finished
their university degrees.

 He rarely sees his GP and has no PMH of note
 ‘I have been having palpitations Doc and its been
bothering me’
SCENARIO 2
 Marilyn is a 15 years old patient who last came to
the surgery two years ago with sore throat which
was treated with Penicillin.
 PMH:
Nil Significant

 Examination Card:

 O/E Temp: 36.8, There is a small early cold sore on
her lip.. Looks Nervous

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SCENARIO 3
 Jake Foster aged 38 He has had Type 2 diabetes
for 10 years and is currently using metformin
850mg tds, gliclazide 80mg 2 bd, pioglitazone
45mg and sitaglitpin 100mg.

 On looking at the notes the Practice Nurse in
diabetic clinic has commented BP is excellent
(130/70), non smoker, alcohol = 12 units per
week, BMI 25 (keen not to put on any more
weight), to see GP in light of persistently elevated
Hba1c (10.5%) re ? referral for conversion to
insulin.
SCENARIO 4
 Samina is 20 years old and works in the marketing
department of a local company. She had little PMH
of note other than acne in her teenage years and a
recent attendance because of concerns over her
irregular periods.

 She is unmarried and lives with her parents.
 BMI 29, prominent facial hair, mild acne and hair on
her arms.
 No male pattern balding, voice normal, no hair on
chest or back

SCENARIO 5
 Man in late 30’s attends surgery because he has
joined a gym and they have asked him to get a note
to say he is okay He’s a smoker and has a raised
cholesterol too. Just wants quick note doesn’t want
to bother the Doctor and annoyed reception wants
him to see one ‘ just for a note’
CSA
 ‘An assessment of a doctor’s ability to
integrate and apply appropriate clinical,
professional, communication and practical
skills in general practice’.
WHY THEY FAIL?
 6. Does not develop a management plan (including
prescribing and referral) that is appropriate and in line
with current best practice or make adequate
arrangements for follow-up and safety netting.
 8. Does not identify patient’s agenda, health beliefs &
preferences / does not make use of verbal & non-verbal
cues.
 10. Does not develop a shared management plan or
clarify the roles of doctor and patient
 14. Does not recognise the challenge (e.g. the patient’s
problem, ethical dilemma etc.)
SUBPLOTS
 WORRIED WELL
 SEEKING EXPLANATION
 UNWORRIED UNWELL
 MISUNDERSTOOD DISEASE
 ANGRY
 CYBERCHONDRIA
 DEMANDING
 FORGETFUL
 NON COMPLIANT/
 SCATTERED
 UNDECIDED
 ANXIOUS ABOUT
 SEEKING SUPPORT FOR
TREATMENT
 HIDDEN AGENDA
 LIST
DUBIOUS THERAPY
 SEEKING SUPPORT FOR
REFUSING THERAPY
DOCTOR’S AGENDA
 REASSURING






APPROPRIATELY
CLARIFYING
SELLING
BEAKING BAD NEWS
CHALLENGING
ADVISING
COUNSELLING
 EMPATHISING
 UNEARTHING
 LINKING
 SUMMARISING
 DIAGNOSING
 EXPLAINING
 DEALING WITH
UNCERTAINTY
CSA: The three domains
1.
DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS :
• Organised and systematic in gathering information from history taking,
examination and investigation
• Identifies abnormal findings or results and/or recognises their implications
• Data gathering does appears to be guided by the probabilities of disease
• Undertakes physical examination competently, or use instruments proficiently
2.
CLINICAL MANAGEMENT SKILLS :
• Makes appropriate diagnosis
• Develops a management plan (including prescribing and referral) that is
appropriate and in line with current best practice
• Follow-up arrangements and safety netting are adequate
• Demonstrates an awareness of management of risk and health promotion
3.
INTERPERSONAL SKILLS:
• Identify patient’s agenda, health beliefs & preferences / does makes use of
verbal & non-verbal cues.
• Develops a shared management plan or clarify the roles of doctor and patient
• Uses explanations that are relevant and understandable to the patient
• Shows sensitivity for the patient’s feelings in all aspects of the consultation
including physical examination