Actor Script — Bed Space 3

History of presenting complaint: You have been having some pain in your abdomen for about 12 hours. It started last night. It was initially a vague, grumbling pain which was around the centre of your abdomen. Over the course of the day however it has progressed towards the right-hand side of your abdomen. It is very tender to touch over that area. You do not want to move because if causes you pain. You have been feeling nauseated and have vomited just before arriving in hospital. You do not want to eat. You have been feeling hot and sweaty.

You have no other symptoms.

Past medical history: Nil of note

Drug history: No regular medication. No drug allergies

Family history: You mother has coeliac disease

Social history: You live in a shared house. You have been recently made redundant and have moved into a shared house to try and save money whilst you are looking for a new job. You do not smoke but have been drinking more recently than you think you should. You buy any alcohol which is on offer at the local supermarket. You are not sure how much you drink each night as it varies. Sometimes it is a bottle of wine, other times it can be 4 cans of beer. It worries you the amount you drink – you wonder if you may have a problem. You do not take any recreational drugs.

Systems review: No other symptoms.

You will be the same character all morning. The simulation is split into two halves. 2 students will be looking after you for each part of the simulation. These will be observed by student observers. The observers are there to provide feedback for the student and should not be involved in the simulation itself. Following each half of the simulation you will be asked to provide feedback from the patient’s perspective.

Students will need to take a history from you and examine you. Your observations will already be recorded on a chart for them to access. They will need to examine your abdomen so please where clothing that enables them to do this. When they palpate your right lower abdomen, this causes a lot of pain. The pain is worse when they press down and when they pull their hand then away (rebound tenderness). You are very reluctant to allow them to touch you due to the pain. You do not want to move much due to the pain. The students may explain to you that it is likely that you have appendicitis and that they would like to refer you to the surgeons. If they ask you to have not eaten since midnight and have not had any operations before. You are nervous about the operation.

You have now had the operation, and you will have a dressing on your abdomen. Please let our team know if you have any allergies. Your abdomen will be very sore still and you feel very sick. You would like something for the pain and to stop you feeling so nauseated. The students should want to complete an A to E assessment of you. Please allow them to do this. You now have generalised tenderness across your entire abdomen. Your bandage across your wound will be heavily blood stained. You blood pressure is low and your pulse is elevated. The students should explain to you that potentially there is something going on in your abdomen and that they will need to contact the surgeons to review you. They may arrange an CXR and a CT scan. This show that potentially your bowel was perforated during the operation. They need to explain this to you. Please be very anxious about this and worried. You are now scared about having any further surgery in case something else goes wrong.