Flavia's bloody stool

Name	Flavia Stocking
DOB	05/12/1977 (37 years)
Occupation	Insurance consultant
History	I noticed increasing amounts of fresh blood whenever I am wiping my bum associated with some pain. It started around a month ago and I have tried to ignore it. I cannot think of what could have caused it. There is no history of trauma. I deny any history of anal sex and I have never inserted anything into my anus. I deny any other symptoms including any change in bowel habits, pain or weight loss. I have no history of prolonged standing or sitting. No other symptoms including no joint pain, rashes or eye symptoms.
Past Medical History	Diabetes which is well controlled with medication
Drug History	Metformin
Family History	Mother has Type 2 diabetes
Social History	Smoking 20 cigarettes per day. No alcohol or recreational drug use. No recent travel

Introduces self	0	1
Confirms name & age of patient	0	1
Explains reason for consultation & builds rapport	0	1
Gains consent	0	1
Asks open question	0	1
Clarifies that it is not haematuria or vaginal bleeding (if female)	0	1
Clarifies whether blood is mixed in with stool, around the stool, dripping from the anus or on tissue paper	0	1
Establishes duration and trigger (if present)	0	1
Establishes character: fresh, dark/melaena, liquid/clots, mucus, smell	0	1
Establishes amount and frequency	0	1
Establishes time course (worsening, continuous, intermittent)	0	1
Asks for alleviating or exacerbating factors (specifically dietary, constipation, prolonged standing or sitting, anal intercourse, foreign bodies)	0	1	2
Asks for associated pain, itching, tenesmus, lumps/piles, prolapse, change in bowel habit, abdominal pain	0	1	2
Asks for IBD symptoms: red eye, joint pain, skin lesions, oral ulcers, bloody diarrhoea	0	1
Establishes if symptoms of anaemia are present: lethargy, palpitations, shortness of breath	0	1
Identifies any red flags: haematemsis, weight loss, loss of appetite	0	1
Asks for any recent illness, bleeding from elsewhere or any family members/contacts with similar symptoms	0	1
Asks if they participate in bowel screening programme (above 60 years in England)	0	1
Elicits past medical and surgical history (specifically previous rectal bleeding or disorders, bowel disorders)	0	1
Asks for any recent foreign travel	0	1
Elicits family history (specifically asking for colon cancer, polyps, angiodysplasia, inflammatory bowel disease)	0	1
Elicits drug history (specifically NSAIDs, warfarin or other blood thinners)	0	1
Checks for allergies	0	1
Checks if patient smokes or drinks	0	1
Asks if any history of illicit drug use	0	1
Checks impact of symptoms on occupation	0	1
Explores and responds to ideas	0	1
Explores and responds to concerns	0	1
Explores and responds to expectations	0	1
Shows empathy	0	1
Avoids jargon	0	1
Summarises back to patient	0	1
Thanks patient	0	1
Patient global score	0	1	2
Gives reasonable differential diagnosis (Haemorrhoids, Anal fissures)	0	1