"I have had a sore throat for two days. The last time this happened I was given antibiotics and it did the trick!"
Facilitator Notes – Aims
History: Straightforward problem; explore past experience of similar complaint
Examination: Pharynx and neck for cervical glands
Management: Symptomatic treatment only — plan needs negotiation; help-seeking behaviour may be addressed
Key challenge: Resist expectation of antibiotics while preserving the doctor–patient relationship
Clinical Details
Only if asked directly:
First day felt very hot with aches and pains; not feverish in the last 24 hours
Mild cough, no sputum
Throat very dry and uncomfortable
Not had time off work
Tried paracetamol and steam inhalations — help a little
About two sore throats a year; not seasonal
Social History
Fashion buyer for Next — going to London in 4 days to buy next year’s collection (first time; must not miss it)
Promoted after Christmas; stressful but enjoying it
Married 12 years (partner works for gas company); two daughters aged 10 and 8
Non-smoker; wine on Saturday night (shares a bottle with partner)
Patient Perspective (ICE)
Ideas: Thinks it is a throat infection.
Concerns: Business trip to London in 4 days — needs to be well.
Expectations: Wants antibiotics as the only way to ensure fitness for the trip.
Demeanour & Negotiation Script
Confident, assertive, well groomed
During explanation of treatment: listen carefully but give no verbal/non-verbal cues until antibiotics mentioned
If ICE identified and doctor explains conflict with clinical practice (checking understanding): listen and discuss rationally
If doctor recommends paracetamol/steam without having asked about self-medication: retort that you already tried them without relief
May reluctantly accept no prescription only if fully involved in discussion; otherwise insist on antibiotics (previous doctor said even if they didn’t work they wouldn’t do harm)
If doctor resists: leave unhappy, say you will come back if it persists
If doctor capitulates: leave triumphant — “Thank you so much, I’m sorry to be difficult but I know when I’m right.”
Information for the Student
Name
Shirley / Steven Mason · Age 40
PMH
Sterilised 3 years ago
Medication
Nil
Recent
3 months ago: registration check, referred for well-woman check. Non-smoker. Occasional red wine. BP 125/80
Examination Findings (only if requested)
Looks well; voice a little husky
Throat: very mild erythema in posterior oropharynx; no swelling, no exudates; central uvula
No palpable cervical glands
Pulse 78 bpm regular · BP 120/78 · RR 14/min · SpO₂ 99% RA · Temp 36.8°C