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Case study 1: Mrs De Bruin

Listen to the audio clip titled ‘Mrs De Bruin’. This is a recording of a consultation done over the phone and try to identify the risks.
Hi, Mary. I’m calling you back from the doctors. How can I help you today? Pardon? Hello? I said, hi. Can you hear me? I’m calling you back from the doctors. Oh, sorry. My hearing isn’t great. OK. Morning. I’ve had an ever so terrible nosebleed when I blew me nose. I mean, I blow my nose all the time, dear. This time, I noticed blood in the tissue. And Sandra, me neighbour, scared me, saying it could be something bad. I came to see the lovely Dr. Roy, but I didn’t have any nosebleeds then. I’ve got high blood pressure, you see? And I can’t be having no nosebleeds. I live on my own. Right, OK. And is your nose bleeding now?
Can you repeat that, darling? Sorry, I said, is your nose bleeding now? No. It’s stopped now. I’ve stuffed tissues in both me nostrils. Right. OK. So how are you feeling otherwise? Well, very worried. Like I said, I’ve got high blood pressure. And I don’t want to bleed and get a heart attack or a clot in me brain. My memory is bad enough. I can’t remember what day it is recently. Right. OK. Well, I don’t think that the nosebleed is something to worry about too much, especially in terms of causing a clot or affecting your blood pressure. Given that this is your first nosebleed, we can probably manage you over the phone.
I haven’t actually got access to a computer at the minute, Mary. But let’s have a chat about how we can manage you at home. And then we can review you in a few days. How does that sound? Oh, well. Oh, right. You’re the doctor, after all.

For your next activity we would like you to listen to the audio clip titled ‘Mrs De Bruin’. This is a recording of a consultation carried out over the phone.

Mrs Mary De Bruin (70 years old) calls the practice because she had a sudden nosebleed while blowing her nose. A couple of days ago she visited her GP because she had a cold. Mrs Smith never suffers from nosebleeds and explains that she is afraid as she has had no history of such bleeds. She has hypertension and diabetes. She takes the following medication: Bisoprolol, Sitaglipin, Aspirin, Atorvastatin and Metformin.

Whilst you listen, make some notes about what goes well and what not so well during the clinical encounter. Consider the following questions:

  1. What are the potential risks of a remote consultation for this patient? You might want to refer back to the list that you created in the last two steps.

  2. Is telephone the most appropriate medium for this consultation? Explain your answer.

Clue! You might like to use the GMC flow chart mentioned earlier on to help you.

Post your responses to the questions in the comments below and take some time to read and comment on at least one other post, and like those that you agree with.

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Conducting Remote Consultations and Triage

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