Name
Taylor Parker
DOB
04/06/1961 (54 years)
Occupation
Security guard
History
I talk very little and am annoyed that I am not talking to a doctor. My wife noticed that I have become increasingly yellow over the last week, although she's unsure of exactly when and where it started. If asked directly, I have had 9 kilograms of weight loss over the last 2 months. I have also noticed my stool has been closer to the colour of clay and my urine much darker than it was previously. I have a really poor appetite and occasionally I feel quite sick. I have not had any pain. I do not suffer from any other symptoms
Past Medical History
Asthma. Never been admitted and well controlled.
Drug History
Atorvastatin, one tablet at night. Allergy to simvastatin
Family History
None
Social History
Current smoker of 30 cigarettes per day over 10 years. Drink alcohol frequently but not excessively with a few beers every other day. 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

If female asks if pregnant (HELLP, obstetric cholestasis)
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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 (Pancreatic Cancer, Alcoholic Liver Disease, Hepatitis B)
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1