Station 54
David Wimpey
Age: 52 years old male
Examiner
Marking Scheme
Data Gathering and Diagnosis
- Begin by thanking the social worker for escalating their concerns and taking the time to report the situation.
- Ask whether the patient is alert and orientated or if he appears confused or drowsy.
- Ask about any signs of shakiness or tremors.
- Ask if the patient has complained of a racing heartbeat or palpitations.
- Explore whether the patient has mentioned feeling unwell — e.g. fever, vomiting, or nausea.
- Ask if either the neighbour or the social worker has witnessed any seizures.
- Ask if patient reports any visual disturbances (e.g. double vision, blurry vision that may suggest ophthalmoplegia)
- Check if there is still ongoing or worsening PR bleeding. If so, assess for possible anaemia symptoms (e.g. fatigue, dizziness, breathlessness).
- Ask about the home environment — whether the house appears unkempt, and confirm if the patient lives alone.
- Explore whether the patient has shown signs of low mood or possible depression.
- Ask if the patient is taking his prescribed medications regularly and whether there is any concern about accidental or intentional overdose.
- Ask whether the patient has a next of kin or family contact and if they are aware of the current situation.
- Inform the social worker that based on the presentation, the patient may be experiencing alcohol withdrawal symptoms and will likely require urgent hospital admission for further assessment and management.
Example of explanation to Adult social worker
Thank you so much for getting in touch and for everything you’ve done so far. It’s clear that David is really struggling, and I appreciate you escalating your concerns.
From what you’ve described, the confusion, shaking, fast heart rate, and heavy alcohol use, he may be experiencing alcohol withdrawal, which can be very serious if not treated promptly. In addition, I’m concerned about the rectal mass previously found and the missed hospital appointments, which could indicate a more serious underlying illness like bowel cancer.
Given the situation, I think the safest and most appropriate next step is for him to be admitted to hospital urgently. There, the team can begin detox safely, treat any immediate medical problems, and restart investigations around the rectal mass.
I’ll also flag to the hospital team that we’ll need to think about discharge planning early on, whether that’s organising a short-term respite care post discharge or extra support at home, so he doesn’t fall back into this situation.
You mentioned his concern about leaving his pets. Would you be able to contact The Cinnamon Trust or the PDSA? They sometimes help with short-term care for animals when owners are admitted to hospital. If not, I can liaise with our social prescriber here to help sort this quickly.
Once David is more settled, we can speak to him about contacting his next of kin with his permission, just so someone else is aware and can offer support if needed.
Given what you’ve described, including his confusion, alcohol misuse, missed cancer investigations, and neglect of his own health and pets, this raises a safeguarding concern. I trust you’ll be escalating this through the safeguarding process. Please keep me updated if there’s any input you need from our side.
Thanks again for your help. I’ll make sure to update you when he’s discharged so we can coordinate the next steps together.
Management
Management
- Offer to organise ambulance for urgent hospital admission. This is to enable medical stabilisation, alcohol detoxification, and further investigation of his suspected bowel cancer while under admission if possible.
- Advice that you will inform the hospital team in advance about his physical and social circumstances to help them coordinate appropriate discharge planning from the outset.
- Advise that post-discharge, an assessment will be arranged to determine if short-term placement in a respite or supported care facility is needed, to prevent future self-neglect.
- Advise that this constitutes a safeguarding concern due to self-neglect and confirm that the social worker will take this forward as part of their role.
- Ask the adult social worker if she can assist in contacting relevant pet welfare organisations such as The Cinnamon Trust or PDSA Vet Charity, to ensure his pets are safely cared for during his admission. If this cannot be arranged, inform her that you can escalate this to your in-house social prescriber for urgent support.
- Once the patient is more stable and alert, seek consent to contact his next of kin (NOK) so that a trusted relative or friend can be kept informed in future emergencies.
- Thank the social worker for her involvement and assure her that you will keep her updated following the patient’s discharge from hospital.
Learning point from this station:
This case station highlights the importance of recognising alcohol-related self-neglect and the potential for serious underlying physical and mental health issues in vulnerable patients. Individuals with alcohol dependence are at risk of alcohol withdrawal syndromes, including delirium tremens and Wernicke’s encephalopathy.
It is also important to understand community-oriented care in general practice, particularly the value of collaborating with allied professionals such as adult social workers. When safeguarding concerns arise, such as self-neglect due to alcohol misuse and missed urgent investigations, it is vital to recognise that adult social workers are an integral part of the adult safeguarding team. Therefore, a separate safeguarding referral is not necessary. Instead, the GP should clearly acknowledge the safeguarding concern, confirm that it will be escalated by the social worker, and maintain clear communication to support multi-agency safeguarding planning.