ROBINSON · STI / Confidentiality

Patient Details

Name: Lucas Robinson (also recorded as Lucas Jaimeson)
Age: 40 years
Opening statement: “I want to know what’s been going on with my wife”

Clinical Details

Two weeks ago you returned from a stint away from home (oil rig). You now have pain on urination and discharge from your penis. You think you have a sexually transmitted infection and you are adamant that you have been faithful to your wife, especially as there are no women on the oil rig and you would never do anything like that as you love your wife and are a man of strong morals.

You know your wife came to see the GP last week and you want to know why. You have asked your wife and you don’t believe her story. You now suspect that she is having an affair and that you have caught something from her — you can’t think of any other reasonable possibility. You state to the doctor/student that they must tell you as they have a duty to inform you as it is something that could affect your health.

Response Guidance

Open questions

If asked to say more about your symptoms or the problem, describe the information above.

Closed questions only

You have previously had a sexually transmitted infection (before you met your wife) so you “know the symptoms.” This was successfully treated.
For the last couple of days: pain whenever going to pass urine; green discharge; no blood; no increased frequency; no fever; no abdominal or back pain.
Eating and drinking as normal; bowels normal; no other systemic symptoms.

Patient’s Perspective (ICE & Feelings)

Ideas: You think your wife has been cheating on you and given you a sexually transmitted infection.
Concerns: That your wife is not being truthful.
Expectations: That the doctor will give you information on what your wife attended with.
Feelings: You are angry that she could have been cheating on you. You work very hard and must be away for work but this means you bring home good money to support your family so you can all have a nice home and lifestyle.

Past Medical History

Appendectomy – appendix removed 10 years ago
Chlamydia infection – 15 years ago

Drugs & Allergies

Nil regular medication
No known drug allergies

Family History

Nil of note

Social History

Married for 12 years – no children
Oil rig worker – spends 3 months away / 2 months home
Never smoked
Alcohol: 2 pints of beer every evening when home; no alcohol when away for work (not allowed on the rig)

Important Social, Cultural or Behavioural Characteristics

You thought that you had a good relationship with your wife and you trusted her while you were away. You don’t tend to argue and you feel you have a comfortable life. You recognise it is difficult being away (for both of you!) but you do it for the good of you both. The thought that your wife could have been unfaithful had never previously crossed your mind until now. You have never been physically or emotionally abusive to your wife. You are someone that stands by their morals and now feel betrayed.

Simulated Patient Non-Verbal Behaviour / Demeanour

You initially are polite and open about why you are there; you are happy to discuss your own symptoms IF the doctor/student asks about them.

Critical: The student/doctor should NOT give you any information on why your wife was at the surgery, what she was diagnosed with, or what her treatment was.

If they do disclose this information → thank them and say you know they should not really have told you and that you know the doctor could get in trouble but you really appreciate it.
If they will not give you any information → become increasingly frustrated, trying every way possible to get just a little information. If the student/doctor does not handle the situation with tact / does not discuss some options for the investigation of your symptoms, ultimately raise your voice. If you reach this point, pause, appear to take a big breath to regain composure and say “well you are obviously not going to help me” → and walk out.
If the doctor approaches the refusal with tact, explains the reason why they can’t give you information, discusses potential options, and brings the consult back to your symptoms and the need to assess/investigate you → you are open to further tests. Still obviously frustrated but more amenable to discussion.

Information for the Student (before consultation)

Name: Lucas Jaimeson · Age: 40
PMH: Appendectomy (10 years ago); Chlamydia infection (15 years ago)
Current medication: Nil · No allergies
Linked household patient: Pammy Jaimeson, 38 years
Wife’s last consultations:
• 3 days ago – Letter from GUM clinic: Diagnosis Gonorrhoea – Treatment IM Ceftriaxone + STAT oral Azithromycin. Declined contact tracing assistance.
• 1 week ago – Dysuria, increased vaginal discharge and post-coital bleeding; triple swabs taken; advised to see GUM clinic
• 1 year ago – Contraception review (POP); advised to think about LARC

Facilitator Aims

For students to deal with a challenging patient
Explore confidentiality within the healthcare setting

The debrief should ensure understanding of principles of dealing with challenging cases and when disclosure of confidential medical information may be necessary.

Primary Care Block · University of Buckingham