A Medical School UK station on MedMock, start to finish

Hello, my name is Priya Shah, I'm a final-year medical student working with the medical team today. Could I just confirm your full name and date of birth, please? I've been asked to have a chat with you about the back pain your GP has sent you in with, is that alright with you? And before we start, are you comfortable at the moment, or do you need anything for the pain?

Leon Grant, that's me. Tenth of April 1968. Yeah, that's fine, we can talk about it. Look, I'm not going to lie to you, the pain's pretty bad at the moment. It came on this morning while I was sitting at my desk editing some photos and it just... it won't stop. I've been pacing around trying to find somewhere comfortable but there's nowhere. I don't want anything too strong though, if that's what you're offering. I've seen what happens when people go down that road with the heavy stuff. Just want to know what's going on, really, and get sorted.

Thank you, Mr Grant, I'm sorry you're in so much pain, and that's completely fair about stronger painkillers, we'll make sure the doctors talk that through with you. I just want to check one thing, because your GP's letter mentioned the pain had been getting worse over the last few days. Did it all start this morning at your desk, or had you had some back pain before today that then suddenly got much worse this morning?

No, no, it all kicked off this morning. I woke up fine, had my coffee, sat down at the desk to do some editing and boom. It just hit me like that. Evil waves of it, you know? One minute I'm fine and the next it's like someone's twisting a knife in my left side. I've been pacing ever since, can't sit still for more than a few seconds. The GP said to come in because it's shooting down into my leg now as well, which didn't happen at first. That's why I'm here today. So it's only been since this morning but it's just... it's relentless, honestly.

Thank you, that's really helpful, so it came on suddenly this morning and comes in waves. Could you point to exactly where the pain is, and show me where it travels to when it shoots down? I'm wondering whether it goes round towards your groin or testicle, or further down the back of your leg towards your foot. And on a scale of nought to ten, how bad is it at its worst?

Right, yeah. It's here on my left side, just above my hip bone. When I point... it's quite deep in, you know? And when it shoots down, it goes sort of down towards my groin area and into my inner thigh. Not so much the back of my leg. It's more down the front and inside. At its worst? God, I'd say nine out of ten. Maybe even a ten when it really hits. I can't think straight when it's at its peak. The only thing that helps a bit is moving around, but even that's not really working today. I've been up and down, pacing, trying different positions, and nothing sticks.

That sounds awful, thank you for describing it so clearly. Have you noticed anything different with your waterworks today, such as any blood in your urine, pain or burning when you pass it, needing to go more often, or struggling to go at all? And have you felt sick or been sick, or had any fevers, shivers or shakes?

Yeah, I have noticed that actually. There's been a bit of blood in my wee, nothing massive but it's definitely there. And I'm going to the loo more often than usual, though it doesn't hurt when I go, thank God. As for being sick, yeah, I was sick once this morning, just the once. I feel a bit nauseous still but nothing since then. No fever though, I don't think. I don't feel hot and cold or anything like that. Just this pain that won't quit and the nausea that comes with the bad waves of it.

Thank you, that's important to know. There are a few other things I need to check so we don't miss anything serious. Have you felt faint or dizzy, or blacked out at all today? And with the pain going into your leg, have you had any numbness or pins and needles in your legs or around your bottom or private parts, any weakness in your legs, or any trouble controlling your bladder or bowels?

No, I haven't felt faint or dizzy, nothing like that. And no, I haven't blacked out. As for the numbness and all that down below, no, nothing weird going on there. My legs feel fine, I can move them about, no weakness or anything. And I'm not having trouble with the toilet either, everything's working normal there. It's just the pain in my side and then it shoots down into my groin and thigh. That's the main thing that's doing my head in. Everything else feels okay, just this one area that's gone mad.

That's reassuring, thank you. Have you ever had pain like this before, or been told you've had kidney stones? And more generally, have you noticed any weight loss you can't explain, night sweats, or any change in your bowels recently?

Yeah, actually, I had something like this before. Must've been about ten years ago now. Had a kidney stone, really painful stuff. They did a scan and confirmed it, said it would pass on its own. I was dehydrated at the time, I think. That's why I've been quite careful with my water ever since, usually drink loads. This summer's been mad with weddings back to back though, long hours, and I haven't been as careful as I should've been. As for weight loss and all that, no, nothing I've noticed. No night sweats or anything odd with my bowels either. Everything's been normal on that front.

That's really useful, thank you, and it sounds like a hectic summer with the weddings. Apart from the kidney stone, do you have any other medical conditions, for example high blood pressure, gout, diabetes or anything with your heart or kidneys? Have you had any operations? And have you ever been told you have a swelling of the main blood vessel in your tummy, called an aneurysm, or been invited for the aneurysm screening scan?

Yeah, I've got high blood pressure. I'm on tablets for that, losartan I think it's called, the one for my blood pressure anyway. And I take something for my stomach as well, omeprazole. That's it really, no diabetes or heart problems that I know of. Never had any operations. And no, nobody's ever mentioned an aneurysm or asked me to come in for a screening scan for that. Is that something I should be worried about? I mean, with this pain in my side, could that be what's wrong?

That's a very fair question. It's something we always think about in anyone over fifty with new pain in the side or back, just so we never miss it, and the screening programme only starts at sixty-five, so it's not surprising you haven't been invited. The way your pain comes in waves, with blood in your urine and a stone in the past, does sound more like a kidney stone, but the doctors will examine your tummy and arrange the right scan to be sure. Can I ask, have you taken any painkillers today, or any other medicines, including anything from the chemist or herbal remedies? And do you have any allergies to medicines?

No, I haven't taken anything yet. Didn't want to take the strong stuff like morphine, you know, after what happened to my mate. He got hooked on it after an operation and it just spiralled. So I've been trying to tough it out, though it's not going great if I'm honest. As for other medicines, just the losartan and the omeprazole I mentioned. Nothing from the chemist or anything herbal. And no, I'm not allergic to anything that I know of. But I'm open to trying something that's not going to mess with my head, if you know what I mean. Just want to get through this without going down that road.

I'm sorry about your friend, that's completely understandable. The good news is that for kidney stone pain the usual first choice is an anti-inflammatory painkiller, which isn't an opiate like morphine, although the doctors will want to check your kidney blood tests and your stomach first. On that note, what do you take the omeprazole for, and have you ever had a stomach ulcer or bleeding from your stomach? And does anyone in your family have kidney stones, kidney problems, or an aneurysm?

Yeah, that's good to know about the anti-inflammatory stuff, that sounds more like what I want. The omeprazole's just something my GP gave me for reflux, you know, heartburn. I don't think I've had an actual ulcer or anything bleeding, just the acid thing. As for family, my mum had high blood pressure like me, but I don't know about kidney stones or anything like that with her. My dad's not around much anymore so I'm not sure what he had. Nobody's mentioned kidneys or aneurysms in the family that I know of. Is that something genetic then, the kidney stones?

Stones can run in families to some extent, but the biggest thing for most people is not drinking enough, which fits with your busy summer, and the team can look into prevention with you once this settles. Could I ask a little about you at home and at work? It sounds like you're a wedding photographer, is that right? Who's at home with you, do you smoke or drink alcohol, and roughly how much would you say you're drinking in water each day at the moment?

Yeah, wedding photographer, that's right. My partner lives with me, we've been together a good while now. As for smoking, I have the occasional cigar, nothing mad. Drinking, I'd say I have a few glasses of wine in the week, maybe eight units or so? Not heavy at all. Water though, that's the thing. During the summer with all the weddings, I've been rubbish at it to be honest. I'm probably only getting a couple of glasses a day when I'm working those long shoots, sometimes less. I know I should be doing better, especially with the stone before. This heat and rushing around, it all adds up.

Thank you for being so honest, that all helps. I'd like to hear what you've been thinking yourself. What did you think might be going on when this started, and is there anything in particular that's worrying you, whether that's about your health or things like work? And what were you hoping we'd be able to do for you today?

Well, when it first hit me I thought it might be another stone, to be honest. The pain's so similar to last time. But then it went down into my leg and I started thinking maybe it's something else, something worse. I got a bit scared, if I'm being straight with you. I've been worried it could be my back or something more serious. Work's been mental this summer so I wasn't surprised my body's given up on me a bit. What I'm hoping for is just... a scan to see what's actually going on, and then a proper plan that doesn't involve me becoming addicted to painkillers. Just want answers and a way forward that doesn't wreck me.

That makes complete sense, and it's natural to be scared when the pain changes. Can I just summarise to check I've got it right? Since this morning you've had severe left-sided pain above your hip that comes in waves, spreading into your groin and inner thigh, with some blood in your urine, going more often, and being sick once, but no fever, no dizziness, and no numbness, weakness or bladder or bowel problems. You had a kidney stone about ten years ago, you have high blood pressure and reflux treated with losartan and omeprazole, no allergies, and you've been drinking much less than usual this summer. Is that right, and is there anything I've missed?

Yeah, that's spot on. That's exactly it. The pain this morning, the waves of it, down into the groin and thigh. Blood in the wee, going more often. Yeah, all of that. And the vomiting, though just the once. No fever, no dizziness, legs are fine, bladder and bowels are normal. Stone ten years ago, blood pressure tablets, the reflux one. Nothing I'm allergic to. And yeah, I've barely been drinking water this summer with all the mad wedding bookings. You've got it right. I just want to know what's happening and get it sorted without the heavy painkillers, if possible.

Thank you. I think your instinct is right that this sounds most like another kidney stone, and pain spreading into the groin and inner thigh is actually typical of a stone moving down the tube from the kidney, and with no numbness or weakness it doesn't sound like a problem with the nerves in your back. I'll pass all of this on to the doctor, who'll examine you, check your blood pressure and temperature, test your urine, and take bloods including your kidney function. The main test is usually a CT scan of your kidneys and bladder, which confirms whether there's a stone, how big it is and where, and also helps rule out other causes such as an aneurysm. We'll aim to get you an anti-inflammatory painkiller as soon as it's safe, many stones pass on their own, and if it's a larger one the urology team can help. In the meantime, please tell a nurse straight away if you get a fever or shivers, feel faint, the pain changes and becomes constant, or you can't pass urine. Does that all make sense, and do you have any questions for me?

Yeah, that makes sense. So it sounds like it could be another stone like before, which is kind of a relief in a way because at least I know what that is. The bit about it moving down the tube explains why it's shooting into my groin now. That's actually helpful to understand. I'm glad there's no nerve stuff going on with my back. So you're saying the scan will show what's there and rule out the other stuff, and then we'll know whether it passes on its own or if I need someone else to sort it out. That sounds like a plan. I'll let a nurse know straight away if anything changes or I get a fever. Cheers for explaining it properly.

You're very welcome, Mr Grant, and you've explained it all really clearly. I'll go and speak to the doctor now so we can get you seen, get some pain relief sorted and get the scan requested. Thank you for your time, and we'll be back with you shortly.

Cheers, Priya. I really appreciate you taking the time to explain it all properly. That's made me feel a bit better, honestly. At least now I know what we're looking for. Just get me that scan and something for the pain that won't turn me into a zombie and I'll be happy. Thanks again.