Mock 10

Clinical Scenario for Role Play: Management of Urinary Problems in a Patient on Oxybutynin

Background Information:

• You are an FY-2 doctor in a general practice.
• Miss Gillian Barnes, aged 54, has come to the clinic complaining of ongoing urinary problems.
• She is currently being treated with oxybutynin, a medication commonly used for urinary incontinence and overactive bladder.

Patient Profile:

• Female, 54 years old.
• Presenting with complaints related to urinary problems.
• Currently on oxybutynin.

Scenario Setup:

• Miss Barnes is concerned about her symptoms and is seeking advice on whether her current treatment is effective or if adjustments are needed.

Patient Prompts:

1. Description of Symptoms:
   • Miss Barnes might begin, "I've been on oxybutynin for a while, but I'm still having issues. I'm not sure it's working as it should."
2. Expressing Side Effects:
   • She may add, "I've also been feeling very dry in my mouth and a bit constipated. Could this be from the medication?"

Clinchers:

• Assessment of Medication Effectiveness and Side Effects:
  • "Let's review how long you’ve been on the medication and discuss how it’s been affecting your symptoms and overall quality of life."

Important Points to Keep in Mind:

• Review of Symptoms and Medication History:

  • Thoroughly assess the type and severity of her urinary symptoms to determine the effectiveness of oxybutynin.
  • Review the duration of oxybutynin use and any changes in symptoms since starting the medication.

• Evaluation of Side Effects:

  • Discuss common side effects of oxybutynin, such as dry mouth, constipation, and blurred vision, and evaluate her experiences in relation to these.
  • Consider the impact of these side effects on her quality of life and whether they warrant a change in medication.

• Consideration of Alternative Treatments:

  • If oxybutynin is ineffective or poorly tolerated, discuss alternative treatments such as other antimuscarinics, beta-3 agonists, or non-pharmacological options like pelvic floor exercises or bladder training.
  • Discuss the benefits and potential side effects of these alternatives to ensure informed decision-making.

Expected from the Doctor:

• Professionalism and Empathy:

  • Approach the consultation with empathy, listening actively to Miss Barnes' concerns and symptoms.

• Clear Communication:

  • Explain the mechanism of action of oxybutynin and why it may or may not be effective for her specific symptoms.
  • Clearly outline potential alternatives, including the advantages and disadvantages of each option.

• Decision Making and Patient Involvement:

  • Involve Miss Barnes in the decision-making process regarding her treatment, ensuring she has all necessary information to make an informed choice.

• Follow-Up Planning:

  • Arrange for a follow-up to monitor her symptoms after any changes in treatment and provide continuous support for managing her condition.

This scenario tests your ability to handle common complaints in a primary care setting, with a focus on patient-centered care, medication management, and effective communication. It provides a realistic task of evaluating and potentially adjusting treatment plans based on patient feedback and clinical judgment.