Feedback on Mrs De Bruin Case Study

The case study is a 70 year old woman with a sudden nose bleed. The patient is clearly anxious about what this might mean, particularly in relation to her existing hypertension.

There are a number of risks that you could have picked up on in this case study. These include:

• The patient seems to be having trouble hearing.
• In the telephone consultation there are not visual cues that might help you to decide if the patient has understood the information provided.
• There are potential capacity issues (memory).
• The healthcare practitioner does not have access to the medical records. The medical records would provide more information regarding frailty, medical history which would impact overall management plan.
• The healthcare practitioner is not the patient’s usual doctor.
• There maybe social issues that need addressing. The patient lives alone and admits that her memory is not as good as it was. Further history taking is needed to explore if she requires further support at home.
• Her age makes her potentially at risk of sepsis, and she has recently had a cold. She may need further examinations.

All of these risks mean that a remote consultation is not appropriate for this patient. The patient should be invited for a face to face consultation.