Shawn O’leary
Age: 51 years old male
Full Case
Patient’s Data
Patient’s name: Shawn O’leary
Age: 51-year-old male
Past medical history
- Temporary registered at the practice
- No known medical conditions
Drug and Allergy history
- No drug history
- No known drug allergy
Recent consultation/Notes
1 week ago – Seen by Dr Ogechi Peters (Clinical Practitioner Access Role)
Presenting Complaints: Patient is a traveller and registered temporarily. Reports 3 months history of tiredness, increased thirst and unintentional weight gain (no baseline weight available)
Examination: Blood Pressure: 138/88 mmHg. General conditions satisfactory
Impression: Tired all the time and unintentional weight gain – underlying cause to be determined.
Plan:Blood investigations, review with results.
Blood Test Results
| Test | Result | Reference Range |
|---|---|---|
| HbA1c | 69 mmol/mol | 20 – 42 mmol/mol |
| TSH (Thyroid Stimulating Hormone) | 2.1 mU/L | 0.4 – 4.0 mU/L |
| CRP (C-Reactive Protein) | 4 mg/L | < 5 mg/L |
| ALT (Alanine Transaminase) | 28 IU/L | 10 – 50 IU/L |
| AST (Aspartate Transaminase) | 22 IU/L | 10 – 40 IU/L |
| ALP (Alkaline Phosphatase) | 85 IU/L | 30 – 130 IU/L |
| Bilirubin | 12 µmol/L | 0 – 21 µmol/L |
| Albumin | 42 g/L | 35 – 50 g/L |
| Full Blood Count | Normal | |
| Urea and Electrolytes | Normal | |
| EGFR | > 90 mL/min/1.73 m² | > 90 mL/min/1.73 m² |
| Bone Profile including Calcium | Normal | |
Note: Patient booked telephone consultation to discuss blood test results.
Patient's Story (Role player’s brief)
Patient’s Story
You are Shawn, aged 51, and you have booked this telephone consultation to discuss your blood test results.
You had the blood tests because you were feeling tired all the time and you noticed you put on weight.
You otherwise feel well in yourself.
Only say below if asked
Social History: You do not smoke and do not drink alcohol. You are a traveller and live in a caravan, currently temporarily registered with this practice. You are moving out of the area tomorrow and are unsure where you’ll be going next.
Your diet is poor, as you often eat fast food and don’t cook, due to your mobile lifestyle living in a caravan.
Family History: Your father had diabetes, and he has since passed away
Ideas: The previous doctor mentioned it might be a thyroid problem or conditions like diabetes
Concerns: You’re more worried about diabetes because your friend lost his foot from diabetes
Expectations: You want to know what the test results show and what to do next.
Say NO to any other questions asked outside of the details already provided in the scenario.
Marking Scheme
Data Gathering and Diagnosis
- Take a history from head to toe
- Ask about blurry vision (suggestive of hyperglycaemia complications)
- Ask about increased thirst and eating habits (polydipsia and polyphagia)
- Ask about chest pain or shortness of breath (screening for cardiovascular risk)
- Ask about urinary frequency or blood in urine (polyuria and UTI symptoms)
- Ask about tingling or numbness in the legs, non-healing wounds, or foot ulcers (neuropathy and early diabetic foot signs)
- Ask about unintentional weight loss or gain
- Explore psychosocial factors: Smoking, Alcohol use, Dietary habits (including reliance on fast food)
- Ask if the patient has housing difficulties or would like support with housing or social needs
- Ask how long he will be in the area, to help plan ongoing care and follow-up
- Give a clear diagnosis of Type 2 Diabetes Mellitus based on symptoms and HbA1c of 69 mmol/mol
Example of explanation to patient
“Shawn, thanks again for taking the time to speak with me today. I’ve had a look at your blood test results and based on everything, including the symptoms you’ve been experiencing like tiredness and feeling constantly thirsty, I do have something important to share.
Your blood test shows a HbA1c level of 69, which is above the normal range. Taken together with your symptoms, this confirms that the cause is most likely Type 2 Diabetes.
Before I explain more, can I just check — what do you already know about diabetes?
(pause for response)
Diabetes is a long-term condition that causes your blood sugar to be too high. If it’s not managed properly, high blood sugar over time can damage the heart, eyes, kidneys, and nerves, even if you don’t feel unwell straight away. That’s why it’s really important we get it under control early.
I remember you mentioned being worried about your friend who lost his foot, and I completely understand why that would be scary. But I want to reassure you: with good control, regular foot checks, and proper monitoring, those kinds of complications can usually be prevented.
Now, I know you’re travelling tomorrow and won’t be in the area. That makes it really important that you: register with a GP as soon as you settle somewhere new and let us know where you’ve moved to, so we can electronically transfer your medical records and help continue your care without delay
In the meantime, we’ll start you on a medication called Metformin. It’s commonly used in diabetes and helps lower your blood sugar. Most people tolerate it well, but some can experience tummy upset or diarrhoea at the beginning.
It’s also important to know about the ‘sick day rules’ for Metformin: if you’re ever vomiting, have diarrhoea, or are generally unwell, you should stop taking it temporarily until you’ve fully recovered, as it can affect your kidneys during that time.
Because you’re moving around, we’ll also prepare a Diabetic Passport for you. This is a small, portable record that includes: your blood test (HbA1c) result, your medications, guidance on recognising complications, like if your blood sugar is too low or too high, what to do and when to seek help
Because diabetes can affect your immune system and make it harder for your body to fight infections, it’s important that we offer you some protective vaccines. I’d strongly recommend you come in for the pneumococcal and flu vaccinations before you leave the area. We’ll also make sure this is recorded in your Diabetic Passport, so any healthcare professional you see in the future knows you’ve had them
One final thing, I’d encourage you to consider getting a medical alert bracelet that states you have diabetes. If anything ever happens and you’re unable to speak for yourself, it helps emergency services know what to do quickly. This bracelet can be gotten from any chemist shop/pharmacy
You’ve taken a really important step today, and I’ll make sure we support you as much as we can before you move. Do you have any questions or worries you’d like to talk through?
Management
Management
- Advise on lifestyle modification: Start by asking if there is any way he can improve his current diet and activity level, despite his mobile lifestyle. Advise to avoid sweetened drinks and processed foods. Encourage a diet that includes high-fibre, slow-releasing carbohydrates (Low glycaemic index) like fruits, vegetables, wholegrains, and pulses, along with low-fat dairy and oily fish.
- Recommend regular physical activity such as walking or simple exercises.
- Offer Metformin 500mg once daily with breakfast for 1 week, then increase to 500mg twice daily with breakfast and dinner for the second week, then 500mg three times daily with meals from week 3 onwards.
- Advise that Metformin may cause tummy upset or diarrhoea, and to contact the surgery or any healthcare provider if symptoms are problematic. In addition, inform patient about metformin sick day rules.
- As patient will be moving out of the area, it’s important to provide him with a Diabetic Passport. This will include his recent HbA1c result, his current medications and guidance on recognising signs of high or low blood sugar, along with advice on what actions to take and when to seek help.
- Diabetes increases infection risk, so offer pneumococcal influenza and COVID vaccines and document in his Diabetic Passport.
- Advise him to register with a new GP as soon as he settles in a new location and to let us know where he has registered, so we can arrange for his medical records to be transferred electronically to ensure continuity of care and safe transfer of medical records.
- Advise on annual diabetic foot checks to prevent ulcers and complications. This can be done at his new GP surgery
- Advise on annual diabetic eye screening to detect early signs of retinopathy.
- Safety net on signs of hypoglycaemia such as shakiness, sweating, and confusion, and advise on what to do if it happens
- Safety net on symptoms of diabetic ketoacidosis such as vomiting, abdominal pain, or deep breathing, and advise to seek urgent medical attention if they occur
Learning point from this station:
This station highlights the importance of delivering a new diagnosis of Type 2 diabetes in a way that is clear, supportive, and tailored to the patient’s unique circumstances. In this case, the patient is a temporary resident and travelling the next day, which presents challenges for follow-up, continuity of care, and long-term condition management.
A key learning point is the importance of providing:
- A clear explanation of the diagnosis and its long-term implications
- Initiation of appropriate treatment (e.g. Metformin) and education on lifestyle changes, sick day rules, and recognising complications
- A Diabetic Passport, which serves as a portable summary of HbA1c results, current medications, and self-care advice
- Offer of pneumococcal, COVID and flu vaccinations, as his diabetes and status as a traveller increases his risk of infections
- A medical alert bracelet, particularly useful for travellers in case of emergencies
A vital learning point is that when patients move away or re-register elsewhere, the preferred and most secure method of transferring their medical records is via electronic transfer between practices. This ensures accuracy, confidentiality, and continuity of care.
Handing the patient paper documents of their health records to deliver to their next GP is not ideal, as it increases the risk of data loss, breaches of confidentiality, or incomplete transfer of medical history.