HISTORY OF LEG PAIN

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The candidate has been given the following instructions:

You are at your general practice placement.  Your GP has asked you to take a preliminary history from 64 year-old Frank Stebbings, who has come in today with a pain in his leg.  Mr Stebbings has agreed to speak to you.

Please take a relevant, focussed history of the problem.  You do not need to take a family history.

The candidate has 5 minutes for this station

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SIMULATED PATIENT SCRIPT

HISTORY OF LEG PAIN

Your name is Frank Stebbings and you are 64 years old.  You are an electrician and still working. You are married and your 3 children have all left home long ago.  You have several grandchildren.

Present problem

• You have come to see the doctor today about a pain in your left leg.  It is a severe cramp-like pain in your calf. It is only in one leg and you do not notice it in your thigh or buttock.

• You first started noticing it about 3 months ago.  It has not really got any worse.

• You only feel the pain when you are walking - it comes on after you have walked about 300 yards on the flat.  It stops pretty quickly when you stop walking. It comes on sooner than 300 yards when walking uphill or into the wind

• You do not feel any pain when you walk up or downstairs or are just standing.  Nor do you experience it when you are resting (sitting watching the television or in bed).

• You haven’t noticed any other symptoms.  You do not have any problems with impotence.

Past medical history

• About 7 years ago you had a small heart attack.  You were in hospital for about a week. It was treated with “clot busters” and, since then, you take aspirin and atenolol (you can trip up over this word).  You don’t know what atenolol is for but you know that aspirin is to stop blood clots.

• You don’t know whether or not you have high blood pressure - no on has ever told you on way or the other.

• Answer “no” to any other questions about your health - query if candidates use jargon.

Other information

• You smoke at least 40 cigarettes a day - you feel quite embarrassed about this.  You did give up for a few weeks after your heart attack but couldn’t keep it up. You know you should not smoke.

• You don’t drink much alcohol - odd couple of pints after work but you have never been much of a drinker.

• You think that your diet is alright - your wife is careful about not frying stuff and doesn’t let you eat butter or cheese and all the things you’d really like to eat!

• You definitely feel that something is wrong, though you haven’t made the connection between the pain in your leg and heart disease.

• It doesn’t particularly affect your work, unless you have a lot of stairs to climb on a job.  However you are upset that you can’t do things with your grandsons that you used to enjoy a great deal - walking in the park, playing football and the like.

This is a 5-minute station.  The candidate is a medical student in your general practice.  The GP has asked you if you will speak to the candidate and you have agreed.  The candidate has been asked to take a relevant history from you