Name
Marcus Avraham
DOB
26/03/1943 (73 years)
Occupation
Retired Librarian
History
I have prostate cancer and have at least 2 years left. It is managed with hormone therapy and I have had radiotherapy to the metastases in my back.

I have had increasing shoulder and upper back pain which is there continuously and which wakes me up at night. It is a dull to sharp pain that is worsened on movement. It doesn't move anywhere and nothing helps with the pain, despite trying regular paracetamol. It is 8/10 in severity. I have no other symptoms. I am worried this means my prostate cancer is more aggressive and it will mean I have less time to live.
Past Medical History
Hypertensive, Hypercholesterolaemia
Drug History
Amlodipine, Atorvastatin, Paracetamol. No allergies.
Family History
Nil
Social History
I have little support as I live alone and my children live too far to help. I find it difficult to shower, get ready in the morning and increasingly difficult to cook. I am in severe need of help. I am not spiritual.


Introduces yourself
0
1

Confirms name & age of patient
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1

Explains reason for consultation & builds rapport
0
1

Gains consent
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1

Briefly clarifies long term diagnosis, management and prognosis
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1

Asks open question
0
1

Site of pain
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1

Onset and time course of pain
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1

Character of pain
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1

Radiation of pain
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1

Exacerbating/alleviating factors of pain
0
1

Severity of pain
0
1

Screens for breathlessness
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1

Screens for constipation
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1

Screens for anorexia
0
1

Screens for nausea & vomiting
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1

Elicits past medical history
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1

Elicits drug history
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1

Checks for allergies
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1

Establishes what patient has tried so far for symptoms
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1

Discusses pain management (massage/TENS, analgesic ladder, adjuvants)
0
1

Suggests to patient that they may need further tests to identify cause (giving examples)
0
1

Asks about spiritual or religious beliefs and whether support is wanted
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1

Asks about social support and mentions services available (e.g. McMillan)
0
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
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