<p> Patient Instructions</p><p>Name of Patient: Dr Mark Walberg – age 56</p><p>Description of the patient & instructions to simulator: </p><p>56 year old GP partner, married with 2 children at University (doing well) Wife developed fibromylagia and is now working part time. He has had to increase to 9 sessions per week 2 years ago to address income shortfall.</p><p>Chronic low back for years, fully invx at MSK clinic with MRI scans etc = wear and tear degenerative change.</p><p>He has no sciatica, no loss of control of water works or bowels and has no altered perineal sensation. Wt is steady, no night pain, no fevers etc.</p><p>Works in a busy Practice 15 miles away. Has become increasing tired and ground down with burden of NHS changes and increasing workload. Stressed but not depressed. Feels unable to reduce his sessions otherwise family will know he is failing.</p><p>Using Tramadol for his back pain as Paracetamol and ibuprofen were no help, physio did not help and he was constipated with Codeine. Tramadol makes him a bit ‘floaty’ but helped ++ with both back pain and helping him get through the nightmare of busy GP days.</p><p>Has bumped wife’s car after a busy day and overuse of Tramadol.</p><p>Note on last script to come in – reluctantly goes so knowing he has been overusing the Tramadol.</p><p>He has not told his wife re stress, back pain and Tramadol over use but she has commented upon him being grumpier than normal. He has not told his GP partners re stress, back pain and Tramadol over use.</p><p>Drinks 10units per week, non smoker, no street drugs No time for hobbies or interests</p><p>Ideas – Tramadol over use may have been identified but it does help him cope with the stressful days Concerns – Tramadol will be curtailed or GP partners may find out regards his problems ‘GP is a small world’ Expectations – A lecture re his Tramadol use but hopes to sweet talk the Trainee GP round </p><p>1 Doctor’s (GP ST) Instructions</p><p>Name & age of patient Mark Wahlberg aged 56</p><p>Summary Card PMH: Chronic low back pain DH: Tramadol 50mg qds prn Allergies: None Non smoker</p><p>Case Notes - Last few entries in records:</p><p>3rd of June Chronic LBP, physio did not help, neither did ibuprofen or paracetamol, try Tramadol</p><p>10th of June – Tramadol helping, placed on rpt</p><p>2 days ago – Note on script re TCI GP (Note Tramadol overuse!),</p><p>2 CSA EXAMINATION CARD</p><p>Patient Name: Marl Walberg</p><p>Examination findings: Normal</p><p>3 CSA Case Marking Sheet Case Name: Mark Wahlberg Case Title: GP with drug problem Context of case </p><p> GP with drug problem</p><p>Assessment Domain: 1. Data-gathering, technical and assessment skills Positive descriptors: Negative descriptors:</p><p> Obtains brief hx re chronic low back pain  Fails to explore low back pain red flags</p><p> Asks about LBP red flags  Fails to identify he is stressed</p><p> Identifies Tramadol overuse  Fails to explore psychosocial aspects</p><p> Asks about alcohol and illicit drug use  Fails to identify he is a GP</p><p> Identifies he is a GP  Fails to asses risk to patients</p><p> Identifies risks re driving and patient care</p><p> Any SUIs? </p><p> Explores stress and depression </p><p> Identifies that wife and GP partners are not aware</p><p>Assessment Domain: 2. Clinical Management Skills Positive descriptors: Negative descriptors:</p><p> Open about concerns regards his mental  Focuses on LBP and misses nub of health and risks to patients and public consultation – sick Doctor possibly when over sedated putting patients at risk </p><p> Offers support services e.g. Doctors  Fails to address the potential issue of Support network or Sick Doctors Trust, patient safety local stress management services,  Colludes with the GP occupational health review etc  Inadequate option sharing  Suggests he discusses the situation with his wife and GP partners  No shared management plan</p><p> Possibly reduces his sessions  No explicit follow up</p><p> Suggests he discusses the situation with  Fails to finish the consultation his appraiser</p><p> Suggests he contact the BMA re advice and support services e.g. Doctors for Doctors</p><p> Offers sicknote for time of work</p><p> Offers pain clinic referral</p><p> Explains he may need to seek advice if GP feels unable to take any of these options</p><p> offers standard stress advice - relaxation, exercise, </p><p> Provides clear follow up</p><p>Assessment Domain: 3. Interpersonal skills</p><p>4 Positive descriptors: Negative descriptors:</p><p> Establishes rapport  Lacks sympathy/empathy</p><p> Non judgement</p><p> Sympathetic/empathetic</p><p>5</p>