Name
Lee Sabatino
DOB
12/12/1948 (66 years)
Occupation
Television presenter
History
I am embarrassed to admit that I have come because I've noticed fresh blood mixed in with my stool. It began a few weeks ago and hasn't really changed in amount. It occurs every time I go and I find myself getting increasingly worried. I have not noticed any change in my bowel habits. I am still going 2-3 times per week. If asked directly, I may have lost 5kg in the last few weeks but haven't been dieting or anything else. I have had no other symptoms (no appetite loss, nausea/vomiting, incomplete emptying, pain). Apart from this I have been feeling more tired for a number of weeks but deny palpitations or breathlessness. I also deny any rashes, joint pain or eye symptoms. I have never experienced this before. I have not had any recent illness nor contact with anyone ill nor have I been abroad recently.
Past Medical History
No history of polyps or bleeding disorders. I do not participate in the bowel cancer screening programme. Have high blood pressure.
Drug History
I take paracetamol for the occasional headache and some medication to lower my blood pressure
Family History
No family history of bowel disorders including cancer. Mother had endometrial cancer at 60 years which was treated successfully. Father has prostate cancer at 90 years.
Social History
I smoke and drink on the weekends but not in excess

Introduces self
0
1
Confirms name & age of patient
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1
Explains reason for consultation & builds rapport
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1
Gains consent
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1
Asks open question
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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
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1
Establishes duration and trigger (if present)
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1
Establishes character: fresh, dark/melaena, liquid/clots, mucus, smell
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1
Establishes amount and frequency
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1
Establishes time course (worsening, continuous, intermittent)
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1
Asks for alleviating or exacerbating factors (specifically dietary, constipation, 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
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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)
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1
Elicits past medical and surgical history (specifically previous rectal bleeding or disorders, bowel disorders)
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1
Asks for any recent foreign travel
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1
Elicits family history (specifically asking for colon cancer, polyps, angiodysplasia, inflammatory bowel disease)
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1
Elicits drug history (specifically NSAIDs, warfarin or other blood thinners)
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1
Checks for allergies
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1
Checks if patient smokes or drinks
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1
Asks if any history of illicit drug use
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1
Checks impact of symptoms on occupation
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1
Explores and responds to ideas
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1
Explores and responds to concerns
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1
Explores and responds to expectations
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1
Shows empathy
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1
Avoids jargon
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1
Summarises back to patient
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1
Thanks patient
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1
Patient global score
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1
2
Gives reasonable differential diagnosis (Bowel cancer, Polyps, Inflammatory Bowel Disease)
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1