INTRODUCTIONThis is a case study concerning a patient presenting with low abdominal pain, frequent micturation and dysuria. I will discuss the consultation and show how I used the problem solving consultation style detailed by Alison Crumbie. This involves listening to the patients' initial complaint and developing hypothetical diagnosis. Focused questioning and clinical examination and investigations will then be used to eliminate some of the initial hypotheses. The patients' perspective of their problem will be addressed and the synthesis of gathered information will enable the practitioner to arrive at a differential diagnosis and to agree on a treatment plan with the patient so that they can manage their problem.
I currently work as a Nurse Practitioner in General Practice in East London. I provide first contact appointments for patients registered with the practice each morning on a walk-in basis. I am a non medical prescriber and generate prescriptions for patients. I work autonomously within my agreed scope of practice and am supported by the structure of a small organisation of professional clinical and administrative staff.
The patient , whom I will call Sue, presented in the walk-in Surgery and told me she had had three days of stinging pain on passing urine, increased frequency of passing water and intermittent low abdominal discomfort. She also said that she had a water infection three months previously and that she thought that she now had the same problem. She had tried over the counter (OTC) medications and had increased the amount of fluids she drank with little effect. She said that her abdominal pain reduced after taking paracetamol but reoccurred after a few hours. She requested a prescription of the same antibiotics she had last time she had this problem.
Forming the initial conceptMy first impression of Sue was that she was smartly dressed,