Station 73
Edward Brown
Age: 74 years old male
Patient
Patient's Story (Role player’s brief)
Opening statement: Hi doctor, I just don’t think my pain is properly controlled at the moment, and my patch keeps falling off after a couple of days. I really need something that works better to help manage it.
You are Edward Brown, a 74-year-old man living with metastatic prostate cancer, which has spread to your bones and causes persistent pain, especially in your lower back and hips.
The pain hasn’t worsened, but it can be disruptive at night and occasionally interferes with your sleep. You are still able to mobilise, and your bladder and bowels are functioning normally.
You’ve been prescribed a Butec (buprenorphine) pain patch, which is meant to last for seven days, but you’ve noticed that it often starts to peel off after just two days. This seems to be due to the fact that you sweat quite a lot, which has always been normal for you and hasn’t been a problem in the past. However, the patch not staying in place has become frustrating, and it’s making you feel uncertain about whether your pain will ever be properly managed.
You’ve tried using the micropore tape provided by the hospital to help the patch stay in place, but unfortunately, it hasn’t made much of a difference. You also use paracetamol when needed, but it’s not strong enough to control the level of pain you’re experiencing.
You’re also aware that you can’t take ibuprofen because of your kidney function, which was explained to you during your hospital care, so you haven’t tried buying any over-the-counter alternatives.
Social History: You live with your wife, who is your main caregiver. You’re retired, but you enjoy reading and watching nature documentaries. You’ve been less active due to the pain. You don’t smoke or drink alcohol. You’re generally in good spirits but feel tired from coping with the pain.
Ideas: You believe the patch may not be staying in place because of your excessive sweating, and that this could be the reason your pain isn’t being well controlled.
Concerns: You’re particularly worried because the pain is starting to affect your sleep and daily routine, making it harder to cope.
Expectations: You would like to discuss alternative pain relief options and get practical advice on how to manage your symptoms more effectively moving forward.
Say NO to any other questions asked outside of the details already provided in the scenario. Accept anything offered to you by the doctor.
Question for the doctor: If the doctor offers you a new tablet for pain, ask whether you should start taking it straight away or wait, since you still have the patch on. If they do not suggest a new tablet, do not ask this question.
A good example of how to ask: “Should I start the tablets straight away once you prescribe them, or do I need to wait since I still have the patch on at the moment?”