Counselling of a Medical Condition

Scenario

Your role: You are the doctor in the general medicine outpatient clinic

Problem: Diagnosis and management discussion regarding Irritable Bowel Syndrome (IBS)

Patient: Ms. Lisa Jenkins, a 29-year-old woman

Scenario:

Your patient today is Ms. Lisa Jenkins, a 29-year-old woman, who has been referred to you by her primary care physician. She has been experiencing chronic abdominal discomfort and alterations in her bowel habits over the past six months, with periods of both constipation and diarrhea. These symptoms appear to exacerbate with stress.

Ms. Jenkins underwent a series of tests - including blood tests, stool tests, and colonoscopy - to rule out other causes, such as inflammatory bowel disease, celiac disease, and colon cancer. All these tests came back normal. Based on her symptomatology and the exclusion of other diseases, your consultant has diagnosed her with Irritable Bowel Syndrome (IBS).

Your task is to discuss with the patient about her diagnosis, the implications of having IBS, and outline the management plan. You are also expected to answer any questions Ms. Jenkins may have regarding her condition.

DO NOT EXAMINE THE PATIENT DO NOT TAKE A HISTORY.

Any notes you make must be handed to the examiners at the end of the station.

Conducting the Station: A Step-by-Step Guide

Establish rapport: Begin the consultation by greeting Ms. Jenkins and ensuring she is comfortable. Confirm her identity and acknowledge her concerns.

Explain the diagnosis: Explain what Irritable Bowel Syndrome (IBS) is, using lay terms. Emphasize that it's a functional disorder related to the digestive system, and the symptoms can vary in intensity and frequency.

Discuss the implications: Make it clear that IBS is a chronic condition, which means it can last for a long time, possibly for life. However, reassure her that it does not lead to cancer or cause damage to the bowel.

Outline the management plan: Explain that managing IBS often involves a combination of lifestyle changes, diet modifications, stress management techniques, and possibly medication.

Lifestyle changes: Regular exercise, adequate sleep, and not skipping meals can help manage symptoms.

Dietary modifications: A diet high in fiber can help regulate bowel movements. She may also want to limit foods that are high in fat, caffeine, and alcohol, or which contain artificial sweeteners. Keeping a food diary can help identify any triggers.

Stress management: Since stress can exacerbate symptoms, stress management techniques such as yoga, meditation, deep breathing exercises, and therapy can be beneficial.

Medication: Antispasmodics can help with abdominal pain and cramping, while laxatives can help with constipation. If necessary, other medications like anti-diarrheals, or even low-dose antidepressants, may be recommended.

Discuss Follow-up: Explain that she should keep regular follow-up appointments to monitor her condition and adjust the management plan as necessary.

Invite Questions: Ask Ms. Jenkins if she has any questions or concerns about her condition or the management plan. Encourage her to share her feelings and concerns and reassure her that it's normal to feel anxious or overwhelmed.

Conclusion: Summarize the main points of the discussion, including the diagnosis, the management plan, and the importance of follow-up visits. Reiterate that while IBS is chronic, it does not lead to more serious conditions and can be managed effectively.