Information Request: Hypertension

MATT FLOYD

89 YEARS, MALE

Role-play cases simulate real clinical practice to guide how candidates respond to clinical scenarios and real life practice.

Your name is Mr Matt Floyd, a 59-year-old lorry driver who recently had a health scare that changed his perspective on life.

Opening Statement: "Thank you for seeing me doctor, I want to discuss my heart and make sure no problems in the future. I have some questions"

If the doctor asks, you will read out the following questions.
1. “Will I have another heart attack?” If the doctor explores: The thought of another cardiac episode terrifies you, and he’s looking for reassurance and advice on how to prevent it.
2. “Do I have to take medication for the rest of my life?” You are anxious about the daily medication with your busy work and wants to understand if there’s any way to manage this. What is you keep forgetting about your meds?
3. “Should I tell my employer?” You needs guidance on whether to disclose his health status to his supportive but professional work environment.
4. “Can I travel to China for my holiday this Christmas? Do I need health insurance?” You and his wife have been planning a trip to China for Christmas, and he’s concerned about the risks and requirements for traveling with his health condition.

HISTORY
Matt's world was turned upside down when he experienced cardiac pain a few weeks ago. He feared the worst—a heart attack. Fortunately, the doctors diagnosed it as angina, but they also found that he has hypertension. This new diagnosis has left John worried about his future.

History is asked:
Life and Family:
Matt is a devoted husband and father. He’s been married for 35 years and has two grown children. His wife is his rock, but she’s also very worried about his health. She’s been urging him to follow the doctors' advice and make healthier choices. Their family life is stable and supportive, but his recent health issues have added a layer of anxiety to their home, his wife does not work.

Lifestyle Changes:
Since his diagnosis, Matt has quit smoking—a habit he’d had 20years. He was smoking about 10 sticks per day and has been able to stop without any problems. He feels better for it and is proud of this achievement. He drinks alcohol only in small amounts, preferring to avoid adding any more strain to his heart. Despite these positive changes, he knows he still has work to do. John loves and eats a lot of fast food. His job as a type 2 lorry driver doesn’t help much either; he’s often sedentary and finds it hard to fit exercise into his routine.

Work Life
Matt loves his job. He finds driving the lorry relaxing and enjoys the freedom it gives him. His employers are very supportive, and he feels valued at work. However, he’s unsure if he should inform them about his health condition. He worries it might affect his job, and he doesn’t want to seem unreliable and lose his driving license.

Emotional State:
Matt has a mix of emotions—proud of quitting smoking, guilty about his diet, and anxious about his heart.

Ideas: You know your diagnosis and that it is important to be healthy. Your wife wants you to make positive changes.

If the doctor ask which is your main concerns:
You will say all is important to you.

Expectations: He’s here today to get answers and to understand how he can live a healthier life while still enjoying the things he loves, like his job and his planned holiday. He wants to take control of his health and ensure he’s doing everything possible to avoid another cardiac scare.

For the Actor:
Show Concern: Display John’s worry about having another heart attack and his overall health.
Pride and Hope: Convey his pride in quitting smoking and his hopefulness for positive changes.
Guilt and Embarrassment: Reflect his guilt about his poor diet and lack of exercise.
Love for Work: Express his love for his job and appreciation for his supportive employers.
Family Dynamics: Highlight the worry of his wife and the supportive nature of his family.

Bring Matt’s story to life with these elements, ensuring the GP trainee can fully engage with his concerns and provide the necessary support.

You are a doctor in your routine clinic, ready to begin your day of consultations. A patient has been booked to see you,

Name: Mr Matt Floyd.
Age:59
Gender:Male
Occupation: Type 2 Lorry Driver

Past Medical History: Hypertension, Angina
Medication History: Amlodipine 5mg 0D. GTN spray
NKDA
QRisk = 21%

Discharge Letter: Date of Discharge: 21 May 2024 (see letter attached)
Admission:
Mr Matt Floyd was admitted to the hospital following an episode of chest pain. The pain was evaluated and diagnosed as angina. During his stay, it was also discovered that John has hypertension.
John was diagnosed with angina. He was started on appropriate anti-anginal medication, including GTN spray and amlodipine.
His echocardiogram was normal.

Discharge Instructions:
1.Continue taking prescribed medications for hypertension and angina as directed.
2.Ensure regular follow-ups with the GP to monitor blood pressure and adjust medications if necessary.
3.Discharge to care of GP.

Sometimes, patient write their questions and present a 'shoping list' list to the GP. It would not be possible to effectively address all concens within a 10-minute consultation, the GP can use the following strategies to efficiently address his concerns and provide comprehensive care:

1. Prioritize and Structure the Consultation:

Agenda Setting: At the beginning of the consultation, clearly set the agenda by acknowledging the main concerns. For example, "Matt, I understand you have a few important questions about your heart health and lifestyle. Let's make sure we cover your main worries today."

2. Active Listening and Empathy:

Show Empathy: Display understanding of his anxiety and concerns. Use phrases like, "I can see why you’re worried about having another heart attack."
Active Listening: Ensure John feels heard by summarizing his concerns, "You’re concerned about your heart, your medication, whether to inform your employer, and your upcoming travel."

3. Effective Questioning:

Open-Ended Questions: Start with open-ended questions to get a comprehensive view of John’s concerns, then use closed-ended questions to focus on specifics. Example: "What are your main worries about your heart health?" followed by "Have you noticed any new symptoms since your last visit?"

4. Provide Clear and Concise Information:

Address each concern briefly, if running out of time you may want to state that you can discuss the rest during follow-up with the patient

Heart Attack Risk: "With proper management of your hypertension and lifestyle changes, we can significantly reduce your risk of another heart attack."
Medication Duration: "It's likely you'll need medication long-term to control your blood pressure, but we can review this regularly."
Informing Employer: "It's important to keep your employer informed for your safety, but we can discuss how to do this appropriately."
Traveling to China: "Traveling is possible with some precautions. Health insurance is essential, and we can discuss any necessary vaccinations."

5. Reassure and Plan Follow-Up:

Reassurance: Reassure the patient about the manageability of his conditions with statements like, "With the right treatment, you can live a healthy and active life."
Follow-Up Plan: "We’ll schedule a follow-up in a few weeks/days to review your progress and any concerns you might still have."

7. Time Management:

Efficient Time Use: You may want to state (at the start of clinical management) that there is a lot to discuss and will try to cover all. Allocate approximately 2 minutes per major concern, leaving the last few minutes for summarizing and planning next steps.
Stay on Track: Gently steer the conversation back if it goes off-topic, "That's important, but let’s make sure we cover your main health concerns first."

8. Note any other issues that need to be addressed, consider adding it as follow-up plan.

For eample, if you are unable to cover the list of questions, mention that you would like to book an appointment with the patient to discuss further.
The patient has high QRisk = 21%, has disclosed he is overwight and has a poor diet and needs statin medication, mention that you would like to discuss this in another appointment (obesity and lifestyle management, and

9. Use Visual Aids and Summaries, if relevant to the clincial situation

Quick Diagrams and Handouts: Provide visual aids or handouts summarizing lifestyle changes, medication schedules, and travel precautions.
Summarize Key Points: At the end of each topic, summarize the key points to ensure the patient understands.

These are the key issues in this clinical scenario.

Key Issues:

Management of New Hypertension Diagnosis: Understanding the initial work-up and confirmation of hypertension.
Starting appropriate antihypertensive medication and monitoring its effectiveness.
Addressing potential side effects and adherence to medication.

Angina and Cardiac Risk Assessment: Managing a patient with a recent angina diagnosis and understanding the implications.
Evaluating and mitigating the risk of future cardiac events.
Implementing secondary prevention strategies for coronary artery disease.

Patient Concerns and Anxiety Management: Addressing the patient’s anxiety about having another heart attack.
Providing clear, empathetic communication to reassure and educate the patient.

Lifestyle Modifications and Patient Education: Counseling on the importance of lifestyle changes such as smoking cessation, diet modification, and regular exercise.
Providing resources and support for making sustainable lifestyle changes.

Occupational Health Considerations: Discussing the implications of the patient’s health condition on his job as a type 2 lorry driver.
Advising on the necessity and process of informing his employer.
Understanding regulations and guidelines related to driving with a cardiovascular condition.

Travel and Health Insurance: Advising on travel safety for patients with cardiac conditions.
Discussing the importance of obtaining appropriate health insurance for international travel.
Providing recommendations on any necessary travel vaccinations and precautions.

Information request can present in different clinical scenerios in clinical practice. GPs should know how to explain complex information in simple terms. You are expected to give the individual additional information to aid their understanding. You should also be prepared to explain diagnoses and treatments in more detail.

1. Practice other clinical scenerios for information request.

2. Medical reports - dealing with requests
https://patient.info/doctor/medical-reports-dealing-with-requests

3. Explaining a diagnosis in an understandable way
https://blog.rvts.org.au/explaining-a-diagnosis-in-an-understandable-way/

Learning Points:

Hypertension Management:Familiarize with the guidelines for diagnosing and managing hypertension.
Importance of regular follow-up and monitoring blood pressure.
Recognize the need for lifestyle modifications alongside medication.

Cardiovascular Risk Reduction:Understand the role of medications such as beta-blockers, ACE inhibitors, and nitrates in managing angina.
Importance of cholesterol management and the potential need for statins.
Implementing a holistic approach to reduce overall cardiovascular risk.

Patient Communication:Develop skills in addressing patient concerns and providing reassurance.
Practice delivering complex medical information in a clear, understandable manner.
Engage in shared decision-making with the patient, respecting their preferences and concerns.

Health Behavior Change:Strategies for supporting patients in quitting smoking, improving diet, and increasing physical activity.
Understand behavioral change models and motivational interviewing techniques.
Recognize the importance of a multidisciplinary approach, involving dietitians, exercise physiologists, and counselors.

Occupational and Legal Aspects:Awareness of the DVLA guidelines regarding medical conditions and driving.
Advise patients on their legal responsibilities and the potential impact on their employment.
Consider the psychological impact of potential job changes or restrictions on patients.

Travel Medicine:Provide guidance on traveling with chronic health conditions.
Discuss the need for adequate travel insurance and what it should cover.
Advise on preparing for medical needs while traveling, including carrying medications and understanding local healthcare resources.

By addressing these key issues and focusing on the outlined learning points, the GP trainee will be better equipped to manage similar cases effectively and empathetically in real-life clinical practice.