Name
Adam Bailey
DOB
27/07/1968 (47 years)
Occupation
Anthropologist
History
My younger son mentioned that I am looking like I have developed a yellowish tan and I thought I should get it checked up. I am quite worried I may have cancer because I can't think of any other reason my skin could have changed colour. Over the last few years I have had increasing joint pain and feeling very tired. If directly asked, admits to being unable to maintain an erection. I have not noticed any changes to my urine or stool. I have not been feeling itchy or noticed any other symptoms.
Past Medical History
Had my appendix taken out when I was 16
Drug History
I occasionally take paracetamol for the joint pain. No known allergies
Family History
My maternal uncle has some sort of liver problem. I don't know any more. My father had a heart attack when he was 65. My mother has COPD which she got at 60 after many years of smoking heavily
Social History
Non-smoker. Do not drink alcohol. No recent travel. Sexually active with wife no other sexual partners

Introduces yourself
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1

Confirms name, age & occupation 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

Establishes duration and trigger (if present)
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1

Establishes evolution (onset to now)
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1

Establishes time course (worsening, continuous, intermittent in Gilbert's syndrome)
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1

Identifies red flags: painless jaundice, weight loss, loss of appetite
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1

Asks for any recent illness, fever or any family members/contacts with similar symptoms
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1

Asks for gallstone/obstructive symptoms: abdominal pain, pale stool, dark urine, pruritus, steatorrhoea
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1

Asks for liver symptoms: abdominal or ankle swelling, easy bruising, confusion, sleep-night reversal
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1

Asks for associated features: joint pain, lethargy, skin hyperpigmentation
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1

Identifies risk factors for viral hepatitis (intravenous drug user particularly needle sharing, blood transfusions outside the UK, tattoos, piercing, needle stick injuries)
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1

Takes brief sexual history signposting before doing this
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1

Elicits past medical history (specifically asking for previous jaundice, diabetes, haemolytic anaemia, inflammatory bowel disease, heart failure, autoimmune disorders)
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1

Elicits family history (specifically asking for viral hepatitis, autoimmune hepatitis, liver cancer)
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1

Elicits drug history (specifically hepatitis B and C immunisation, antibiotics, tuberculosis medication, antiepileptics, herbal medication)
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1

Asks for any foreign travel and consumption of raw food
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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

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 (Haemochromatosis, Hepatitis B, Autoimmune Hepatitis)
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1