Communication Station 3

 

Station 3

A case of hypertension

 

Candidate Instructions

Setting:

You are an FY2 doctor working in a GP practice. A patient has come to see you as she has some concerns about her blood pressure.


Mrs Eileen Thomas


Tasks:

1. Take a brief history from the patient.

2. Interpret the provided investigations to the examiner

3. Explain the diagnosis and discuss your management plan with the patient.

Simulated Patient Instructions

Briefing

Diagnosis: Stage 2 Hypertension
You are Mrs Eileen Thomas, age 54.
You have come to see your GP about high blood pressure readings taken at home.

Opening statement

“My father has recently been given a home blood pressure machine and when I used it my readings came up as what my dad said was too high as that’s what his GP told him. So I borrowed the machine to see if it was just one off reading but it doesn’t seem to be.”

Appearance and Behaviour

Anxious

Information to Give Freely

I have a list of readings here if you want it.

Presenting Complaint

Repeatedly high readings on your father’s home BP machine - no other symptoms

Past Medical History

You haven’t had your BP checked in a long time as you rarely go to the GP
Other medical conditions - nil

Drug History

Prescribed - nil
Over the counter - multivitamins
Allergies - nil
Recreational drugs- nil

Family History

Father - high BP and high cholesterol

Social History

Smoking - smokes 5/day for 10 years
Alcohol - occasional, social drinker. A couple of glasses of wine a week
Job - housewife
Exercise - Yoga

Systems Review

No symptoms

Ideas / Concerns / Expectation

Ideas - “I think I have high blood pressure like my dad”
Concerns - “I'm worried about the high readings”
Expectations - “I'd like you to clarify what my BP should be and to be started on blood pressure medication please”

Discussion / Questions

You know that hypertension is high blood pressure but known nothing about stages or treatment. You know your father takes a tablet that helped and you want one of these too. You are willing and receptive to lifestyle change but are not sure what these changes involve.
If blood pressure tablets are mentioned ask "are there any side effects doctor?"

Start the Timer and Begin

Intro

 

Presenting complaint

 

Past Medical History

 

Drug History

 

Family History

 

Social History

 

Systems Reviews

 

Ideas, Concerns, Expectations

 

Examiner Instruction

 

At this point please direct the candidate to review the blood pressure readings.

Interpretation

 

Examiner Instruction

 

At this point please direct the candidate to explain the diagnosis and management to the patient.

Explaining Skills

 

Summary

 

Learning points;

  1. Stage 2 HTN often requires both lifestyle and drug interventions.

  2. Lifelong drug treatments always require careful counseling and most long-term drugs will require some form of monitoring (e.g. ramipril = renal function).

  3. All stages of hypertension will require regular check-ups to monitor for micro and macrovascular complications of high BP and medication titration. This is done through the GP.

  4. HTN refractory to treatment or in patients <40 years old would require investigation for secondary causes.

  5. A general structure for explaining skills; gather information - assess the patient’s prior understanding - assess their desire for knowledge - explain the topic with simple language - summarise and answer questions - offer information leaflets / further resources.

Submit for Scoring

Tags | Explaining skills | HTN counselling | Hypertension counselling

Station Written by: Dr Joanna Mantio

Peer Reviewed by: Dr Benjamin Armstrong