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Diagnosing acute appendicitis: a case study

10 October 2024
Volume 33 · Issue 18

Abstract

Advanced clinical practitioners (ACPs) are experienced health professionals educated to master's level. They are accountable for the assessment, diagnosis and treatment of individuals, and are responsible for making complex decisions. The case study presented in this article critically analyses the consultation involving a male patient in his sixties with a 2-day history of abdominal pain, who was referred by his GP to a surgical assessment unit. Analysis was carried out using the Calgary-Cambridge Model. The article discusses history-taking, abdominal examination and differential diagnoses, and presents the process of how the trainee ACP arrived at the diagnosis of appendicitis.

Consultation models provide a structure for the two-way interaction between patient and clinician, usually initiated when the patient is ill. Seminal work has been used in this case study as there is limited evidence for nurses' consultation styles. There is a variety of consultation models, from medically focused ones (Byrne and Long, 1976) to more shared approaches (Silverman et al, 2013; Neighbour, 2017). The Calgary-Cambridge Model, developed by Silverman et al (2013), is used widely to teach consultation skills. It comprises five steps (Figure 1):

For the purpose of this case study, this model is used to critically analyse a consultation with a patient referred by his GP to a surgical assessment unit, following a history of abdominal pain. This model was chosen because it is structured, patient-centred and facilitates shared decision-making.

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