|
96 |
Role-play. Previous SB. ↑ BP. IUGR. Complaint. |
|
97 |
Viva. Asymptomatic bacteriuria and
pregnancy |
|
98 |
Role-play. Transgender. Menorrhagia. Emily,
Rob |
Candidate’s instructions.
You are a year 5 SpR. Andrea
Mather has booked for care in her second pregnancy. Her first baby was
stillborn at 39 weeks. The midwife who did the booking has asked you to see her
to discuss the implications for this pregnancy. Dr. Reid, the consultant, has
said that you need to learn how to deal with difficult situations, but to
discuss your proposed management with her before the patient leaves the clinic.
GP referral
letter.
Please see Andrea Mather
who is pregnant for the 2nd. time, LMP 26th. June. Dr.
Jones, a young colleague, who has a particular interest in obstetrics and is a
member of the RCOG, scanned her today and the pregnancy is viable, looks normal
and the gestation fits with the LMP.
Sadly, Andrea’s first
pregnancy ended disastrously: the baby was stillborn. Andrea and her family
have concerns about the care she received at the hospital and believe that she
should make a formal complaint. I have spoken to Dr. Reid by phone to alert her
to this sensitive issue. The problem is that Andrea was referred by Sister
Williams, our midwife, at 38 weeks with hypertension and an impression of IUGR.
Andrea says that no investigation was done, not even a scan. She was discharged
and told to see Sister Williams a week later. Sister Williams had the nasty experience
at that appointment of having to inform Anrea that fetal heart activity could not
be detected. Dr. Jones was not available to scan her, but a scan at the hospital
confirmed FDIU. The baby only weighed 3 lb. I had a letter from a Dr. Reynold’s
after Andrea’s follow up visit six weeks later. He indicated that he was a SpR.
The letter was very brief and only stated that no explanation was found. I
presume that some kind of perinatal review process was instituted, but I have
not received any information about this or any conclusions or recommendations.
Andrea has been greatly
traumatised but has had good support from Jane, your bereavement midwife,
Sister Williams, Dr. Jones and Susan, our health visitor. Andrea’s mother, who
used to be a nurse, has made it clear that she believes Andrea’s care was negligent
and that Andrea should complain. Dr. Reid is aware of this. I should be most
appreciative if Andrea could be under senior review and I could have a comprehensive
plan for the pregnancy and delivery so that Dr. Jones, Sister Williams and I
can give her the maximum support during what is bound to be a very stressful time.
Yours sincerely,
Mary Goodfellow.
97. Viva. Asymptomatic bacteriuria and pregnancy.
Candidate’s instructions.
The
examiner will ask you 14 questions – and maybe a few more as I have written
this question today and may yet think of a few more.
98. Role-play. Transgender. Menorrhagia. Emily, Rob.
This
question was written by Emily Wright, prompted by teaching on transgender issues
by her colleague Rob Cumming.
Candidate’s
instructions.
You are an ST5 doctor in the gynaecology
clinic, your next patient is Mr Michael Williams; you have received the following
letter from the GP.
Take a history from the patient and make a
management plan.
Dear Doctor,
I would be most grateful if you could see
Michael Williams, a 23-year-old transgender man. He is currently suffering with
menorrhagia. He was referred to the gender identify one year ago but the
waiting list for a first appointment is two years. I would be most grateful for
your expert opinion - I know Michael is quite keen to discuss surgical options.
No comments:
Post a Comment