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Name
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Mikhail Collins
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DOB
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26/03/1954 (62 years)
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Occupation
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Chemist
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History
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I have inoperable bowel cancer and have less than 3 months left.
I do not thing I deserve this and feel quite horrible about it. I do not
engage with student. The bowel cancer has been managed conservatively and
apart from some rectal bleeding and severe less of weight (10kg in 3 months),
I have had no symptoms until now.
I have now been feeling incredibly nauseated for 3 weeks and
have vomited my food on several occasions, with no blood present. I am also
hardly eating as I have severe loss of appetite: single fruit for breakfast,
half a jacket potato for lunch, usually skip dinner. I have had no other
symptoms. If directly asked, spicy foods tend to make it worse. I have tried
eating less spicy food. I want to know what's causing it and how I can sort
it out as I don't want to die feeling this unwell. I also want my appetite to
return and wish for suggestions on what I can do to eat properly and prevent
further weight loss.
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Past Medical History
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Nil
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Drug History
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Paracetamol
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Family History
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Father and brother with bowel cancel.
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Social History
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I drink 5-6 pints of alcohol daily. I know this is above the
limit but don't see the point of cutting down. I do not realise that nausea
and vomiting may be due to excessive alcohol. I receive support from my
neighbour with shopping and am able to cope with my daily activities with the
help of carers that come three times per day. I am not spiritual.
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Introduces yourself
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0
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1
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Confirms name & age
of patient
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0
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1
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Explains reason for
consultation & builds rapport
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0
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1
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Gains consent
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0
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1
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Briefly clarifies long
term diagnosis, management and prognosis
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0
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1
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Asks open question
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0
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1
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Onset and time course
of anorexia
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0
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1
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Duration and changes to
anorexia
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0
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1
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Exacerbating/alleviating
factors of anorexia
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0
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1
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Clarifies what patient
eats
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0
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1
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Asks about weight loss
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0
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1
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Assesses volume
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0
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1
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Checks if there is any
blood
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0
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1
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Establishes onset and
number of events
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0
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1
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Asks if there were any
triggering events
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0
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1
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Specifically screens
for NSAID overuse (peptic ulcer)
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0
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1
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Screens red flags of
dysphagia, melaena, loss of appetite and weight loss
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0
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1
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Screens for pain
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0
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1
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Screens for
breathlessness
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0
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1
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Screens for
constipation
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0
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1
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Screens for anorexia
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0
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1
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Elicits past medical
history
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0
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1
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Elicits drug history
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0
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1
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Checks for allergies
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0
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1
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Establishes what
patient has tried so far for symptoms
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0
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1
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Discusses anorexia
management (frequent small meals, supplements/dexamethasone)
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0
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1
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Discusses nausea &
vomiting management (small meals/avoiding trigger foods, antiemetics)
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0
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1
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Suggests to patient
that they may need further tests to identify cause (giving examples)
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0
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1
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Asks about spiritual or
religious beliefs and whether support is wanted
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0
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1
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Asks about social
support and mentions services available (e.g. McMillan)
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0
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1
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Explores and responds
to ideas
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0
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1
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Explores and responds
to concerns
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0
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1
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Explores and responds
to expectations
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0
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1
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Shows empathy
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0
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1
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Avoids jargon
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0
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1
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Summarises back to
patient
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0
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1
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Thanks patient
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0
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1
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Patient global score
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0
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1
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2
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