Tutorial 29 September 2011

Websitewww.drcog-mrcog.info.
Tutorial.
A recent exam had an OSCE station in which there was an inappropriate GP letter.
I have produced my version.
The candidate's instructions are:
1. to detail what is wrong with the letter,
2. to say what you would do apart from dealing with the clinical issues.

Candidate’s instructions.

List the things that are wrong with this letter.
What action would you take after seeing the patient?

The letter read as follows.
The Medical Centre,
Green Lane,
Broadforth-on-Sea.
Your ref: BRI 91/54843.

Re. Jennifer Houseside,
45 The Maltings,
Broadforth-on-Sea.

Please see this woman who complains of unacceptably heavy periods. She is a huge, malodorous whale and I do not envy you the task if you feel that you have to examine her. She is as stupid as she is fat and full of idiotic ideas that she gets from her equally stupid mother. She is too thick for logical reasoning to have any impact on her stupid views.
The father is a dirty, unpleasant sort and I would not be surprised if incest had contributed to their low IQs. If the human race has advanced though evolution and natural selection, what on earth were their ancestors like?
They are social parasites. None of the family has ever worked and they live off Social Security payments. I have had the misfortune to have to do the occasional home visit to various members of the family. They live in disgusting squalor. If they were pigs their living conditions would give the species a bad name. Theirs are houses in which you wipe your feet on the mat as you leave and not as you enter. They always ask you to sit, but I would not wish to ruin my clothes. And their hospitality extends to offering cups of tea, but I would rather take my chance with neat hemlock.
However, despite living on Social Security payments, they have the latest widescreen TVs and associated DVD equipment. The husband looks to me as though he indulges in low-level crime, probably shoplifting. He is a shifty character whom you would not trust and I would advise you to make sure that all valuables are locked up and out of sight when she or any of her family is around. One brother is in prison for theft to feed a heroin habit, which typifies the contribution this family makes to the greater good. Her sister is believed to be a prostitute. Certainly she has a lot of children and I doubt that any of them have the same father or that she would be able to enlighten them as to who their fathers might be. She (the sister) is a regular visitor to the Sexually Transmitted Diseases clinic where she displays a surprising range of conditions needing treatment. The sister is as fat and ugly as my patient, making one marvel at the mentality of her clients. I cannot imagine how anyone would want sexual relations with her, far less pay for the privilege.
I wish you well in your dealings with her and apologise for sending such an unpleasant lump to your clinic. This is a family that makes you wish the Abortion Act could be made retrospective!
Please do your best not to send her back to see me.
Yours sincerely,

 We then decided that it would be a good idea just to deal with this referral letter with all the abusive and inappropriate stuff removed.

We then had what would seem a very simple station about menorrhagia. As you will hear, the roleplayer was brilliant and made it a most interesting station.

The referral letter would now read:

The Medical Centre,

Green Lane,

Broadforth-on-Sea.

Your ref: BRI 91/54843.

Re. Jennifer Houseside,

45 The Maltings,

Broadforth-on-Sea.

 

Please see this woman who complains of unacceptably heavy periods.

Yours sincerely,

Jon Poutmouth.