UBMS · Actors Scripts 11th Sept · History and examination station

Actor 2

Use your own name and age.

History

You have come to see the GP because you have a headache. The headache is like a tight band across the front of your head. It is there most days but seems to get worse during the day. It can range from 4–6/10 most days. You have some tension over your neck and shoulders. Paracetamol helps a bit.

You have no fever, nausea or vomiting. You have no change in your vision, hearing or sense of smell. You have not woken with the headache. You have not had a head injury. You have no rashes. You have no weakness or numbness in your arms or legs or change of sensation. You have not lost consciousness or had a seizure.

If asked how you are feeling

Your sleep has not been great recently. You have been struggling to get to sleep but waking early. You are feeling really tired most days as a result.
You used to like to read and knit however you are finding this difficult. You can’t seem to concentrate for long. You also don’t seem to enjoy them like you did before.
You seem tearier. You are not sure why. Things just seem quite tough at the moment.

You have hypertension and are taking ramipril 5 mg. You are not allergic to anything. Your mum died of breast cancer in her 60s and your father died of a heart attack 5 years ago aged 80.

You live with your partner. You do not work. You do not smoke. You drink 2 glasses of wine a night to help you sleep. You do not take any illicit drugs.

Only give the further information below if the student explores the home environment more, or responds to cues about your mood.

You are carer for your partner who has dementia (Alzheimer’s). They were diagnosed years ago; you cannot really remember when.
They have needed more help over time. You gave up your job as a teacher to care for them after you had to pick them up from A&E because they had severely burnt themselves cooking and did not remember what had happened.
You now feel they are not safe to be left alone. They are prone to wander, so you keep the house door locked and hide the keys. You tried alarm mats at the door but they are surprisingly quick and you worry you would not respond fast enough, even at night.
Financially things are tight. Your partner receives PIP and attendance allowance, and you receive carer’s allowance, but it is not a lot. Your partner has a pension which you can access as you have lasting power of attorney for finance and health (signed years ago when they still had capacity). Without your salary it is difficult to get by.
Your partner has recently been getting worse. They do not always remember what time of day it is or where they are. They forgot your name the other day, which really upset you. They get frustrated and very angry. They have not hurt you, however you are worried that this could happen.
You love them very much. You would appreciate any help and support. You do not want to be referred to social services. You are worried they will think you cannot look after your partner and will put them in a care home.

ICE

If the student only elicits the headache: You think you are having migraines. You are worried it may be something more serious such as a tumour as the headache is not going away. You would like to be referred for a scan.

If they explore more about your partner: You think everything is probably related to stress. You are worried you are not coping and that your partner will be taken away from you as a result. You would like more help.

Examination

The student should offer to examine you. They may take your BP, pulse, oxygen saturations and temperature. They may look into the backs of your eyes and perform a neurological examination (looking at and moving your arms and legs, and testing sensation with a blunt pin). Ask why they want to do the test and allow examination if you feel comfortable. Feedback if you feel any pain or discomfort. Wear a T-shirt to help enable examination.