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      Elizabeth Freeman

      Age: 50 years old female

      Full Case

      Station List
      Patient
      Doctor
      Examiner

      Patient's Data

      Patient’s name: Elizabeth Freeman

      Age: 50 years old female 

      Past Medical History

      • Osteoarthritis
      • Asthma

      Medication history/ Allergies

      • DuoResp Spiromax (MART) 1 puff BD

      Patient's Information

      You are Elizabeth, 50-year-old female. You are here to report some concerns as regards your last consultation with Dr. Barnes.

      You had booked to see Dr. Barnes because your osteoarthritis pain in the right knee was not controlled with topical ibuprofen. During the consultation, you noticed the doctor looked exhausted, had red eyes and was sleepy like he had not rested for many days.

      He rushed the consultation and did not even examine your knees like other doctors would do.

      He then prescribed amitriptyline. You experienced dizziness as a side effect of amitriptyline and you were not told about this side effect. When you checked this up, you saw that amitriptyline is an antidepressant and a neuropathic pain medication and do not agree with Dr. Barnes judgement. You had to get codeine from the chemist and this is helping with your pain. You no longer feel dizzy since stopping the Amitriptyline.

      Idea: You think Dr. Barnes was not fit to see you on the day he saw you.

      Concerns: You are worried about other patient he saw on that day and their safety.

      Expectations: You want the doctor to tell you how to file a complaints.

      Questions for the doctor

      Was Dr. Barnes decision to prescribe amitriptyline the right thing to do?

      Recent notes / Consultation

      Seen by Dr. Phil Barnes (Clinical practitioner access role) 2 weeks ago

      History: Recent X-ray confirmed osteoarthritis of right knee.

      Patient says pain is not controlled with topical ibuprofen and sometimes affects her at night. No red flags, walking freely and not limping.

      Plan: Start on Amitriptyline 25mg nocte. Worsening advice given.

      Patient booked telephone consultation to discuss some concerns.

      Marking Scheme

      History

      • First—Acknowledge her complaints—I’m sorry to hear about your experience, I’m not sure why this happened, however, we will investigate to find out what happened and put measures in place to prevent this from happening.

      Let’s discuss the next steps we’ll take to address this OR you can say— thank you for sharing your concerns. I’m sorry to hear that you felt uncomfortable during the consultation, and I want to assure you that we take this matter seriously. Can I ask few questions to help understand what happened to see how I can be of help?

      • How is your knee pain now? Does it feel better? Are you still in pain? Do you need any further painkillers?
      • You mentioned amitriptyline made you feel dizzy; did you experience any further reaction? have you stopped the medication? Has the dizziness subsided? How are you feeling now since stopping the medication? Did the amitriptyline provide any pain relief before the side effects occurred?

      Patient booked routine appointment to discuss concerns

      • Can you describe more about how the doctor appeared during the consultation?
      • When you say the doctor seemed sleepy, what specifically made you feel this way? For example, was there a change in their speech or actions that concerned you?
      • Did this behaviour impact how comfortable you felt during the consultation or the care you received?
      • Do you have any other concerns about your consultation with my colleague.
      • What outcome would you like to see as we address your concerns OR was there anything specific you were hoping for or that you would also like me to address?

      Management

      Management

      • Acknowledge her concern again- “Thank you for sharing your experience. I’m very sorry to hear that the consultation left you feeling uncomfortable and that the amitriptyline caused dizziness. You made the right decision to stop taking it, and I’ll work with you to find a better treatment plan for your knee pain.
      • Firstly—if she is still in pain, you can offer alternative painkillers—you can also discuss physiotherapy, joint injections etc. • If she still has dizziness, then she can be booked another appointment to discuss the dizziness in detail.
      • Explain the Complaint Process: I will forward your concerns to the practice manager for review. Your feedback will help us ensure the highest standard of care. If you prefer, we can keep your identity anonymous while addressing this issue. You can also file a complaint using our feedback and complaints email which is monitored by the practice manager
      • We will acknowledge your complaint within three working days. Investigating this thoroughly may take some time, but we will keep you updated as appropriate.
      • Inform the patient that —You will also speak to the doctor to understand the doctor’s account of the consultation.
      • If the patient wants her complaints to be anonymous, Re-assure patient that we can address her concerns while ensuring her anonymity.
      • If further painkillers are prescribed, then a follow up for that should be organized.
      • Inform her that she will be informed of the progress of the investigations and outcome.

      How do you reply to her question as to whether your colleague did the right thing by prescribing amitriptyline?

      Thank you for your question. Amitriptyline is often used to manage certain types of pain, especially nerve-related or chronic pain that may not respond well to standard painkillers. I can’t fully comment on Dr. Barnes’ decision since I wasn’t involved in you care at the time or able to assess the situation as he did. However, we can review your treatment plan if you are still in pain and see how best we can manage your situation.