Clinical Skills- Formative Assessment.
Bridget McCarty. Tutor: Sharon Jones
* D: So Stacey do you want to tell me why you came into the doctor today? P: Um, uh yesterday I sort of fell down my stairs, going to, going to work and I did something to my ankle, D: Mmhmm
P: And it’s just it’s really really sore. Yeah.
D: Cool, how did you fall down the stairs?
I chose this segment because it is at the beginning of my consultation after initiating the session and it is very important. I thought I started off well by asking a good open ended question and receiving a good reply from the patient as to what happened. I used encouraging nods and “mmhmm” however, there were definitely multiple other questions I could have used instead of the second question I asked. I should have asked if there was any other reason that brought her into the doctor today and if not set the agenda for the session and then asked her more about her presenting problem which was falling down the stairs. * P:It was quite icy yesterday and our stairs are pretty bad, I was rushing to get to work and I sort of slipped, and um and sort of rolled it, sort of rolled my ankle and then like it was really really sore but I had to keep going because I had to get to work D: Right, okay, so you walked on it yesterday?
This was a good clarifying question to ask, but perhaps should have been used later on in the consultation when trying to find out more specific details. This would have been a good time to acknowledge the amount of pain the patient was in and recognise the inconvenience for her as she still had to go to work even though she was in significant pain. After this, I could have maybe asked what kind of pain it was? Referring to dull, sharp etc but not mentioning the types, letting her describe it herself and if she didn’t understand asking her to explain what the pain feels like. * D: Um have you noticed that it is, um particularly sore at any points of the day between yesterday and today or is it just generally just...... P: Just generally when I am walking around and stuff
Good question at an appropriate time but I need to not trail off at the end of my sentences or lead onto any particular answer. I should have stopped after today? Didn’t need to even say or start saying the last part to get the response I was requiring. I chose this segment as I know this is something I need to work on as I do it quite a lot when I really don’t need too. TASK TWO
1. What was the reason for the patients presentation?
Stacey had come to the doctor because she fell down the stairs the previous day and hurt her ankle. The stairs were very icy and she slipped. She felt like she had rolled it and it was sore on the lateral side of the right foot and the pain was radiating down the sides towards the toes. She also mentioned she noticed bruising that morning. 2. Did you explore the problem from the biomedical perspective? From the patients perspective? I did explore the problem from a biomedical perspective and found out where the pain was and what movements it was affecting. I also partly explored it from the patients perspective by asking what she is concerned most about the injury, what her expectations were about coming to the doctor and how it is affecting her daily life. However I could have asked what does she think may be causing this because it was only at the end after the summary that she told me this information when if I had of asked the question earlier I would have been able to gather this information earlier. 3. Which particular communication skills did you employ to gather this information? I used eye contact with the patient, and used non verbal encouragement quite a lot; and tried to use silence to allow her time to tell me more I sometimes used repetition in my own words of what they had said by summarising at the end and allowing her to correct me if I had anything wrong. I used open questions at the start but didn’t...
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