GPS3 SCP12
GP Stage 3 Simulated Consultation - Patient 12
You are an SHO in General Practice and your next patient is Henrik, a 30 year old professional cyclist. You note that Henrik saw one of your colleagues last week complaining of a cough and was advised that this was a likely viral infection that would resolve with time.
You are Henrik, a 30 year old professional cyclist who has arranged an appointment at your GP surgery. Unfortunately, you have performed poorly in recent cycling races and you are concerned that you will lose your space for next seasons Tour De Belgium. One of your colleagues was recently prescribed an inhaler from his doctor, and this has significantly improved his performances. You have been able to buy an inhaler from the internet but require a prescription from the doctor so that this can be used during the upcoming cycling tour. You are unsure about the name of the inhaler or what it contains, and believe that it is ‘just the standard inhaler’.
You do not have any cough or respiratory symptoms and you are not keen for the doctor to examine you as you feel this would be a waste of time. You cannot understand any doctor who states that they cannot prescribe an inhaler, given that you already have the inhaler and have found it to improve your cycling performance in trial runs without any side effects. Furthermore, you feel that it is the job of the doctor to make you ‘feel better’. Any mention of ‘cheating’ is not taken well, and makes you more aggressive given that all of the other cyclists are being prescribed inhalers by their doctors. You plan to arrange a doctor with a private doctor if this doctor is unable to meet your requests.
Away from cycling, you have recently split from your partner after you discovered her cheating on you whilst you were on a cycling tour. As a result, you are having difficulty concentrating on your cycling with occasional panic attacks and this may also be affecting your performance. You have started to smoke; you do not drink and have an otherwise healthy diet and lifestyle.
Consultation Focus
This consultation is less about refusing an inappropriate prescription and more about appeasing an upset patient, exploring Henrik’s reasons behind wanting a performance enhancing medication, explaining the potential long term negative implications of taking an unspecified inhaler as well as identifying the social circumstances which have underpinned Henrik’s decline in cycling form. Accepting and addressing these underlying social concerns through appropriate therapy and follow up appointments would likely be more beneficial than any short term performance enhancing medication.