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A virtual patient will never be a substitute for a real patient. Open questions, active listening and following cues is important in any history but essential in talking to a patient with depression. It is also very important to build rapport and empathy and to give an indication that you understand how difficult it can be for them to relive their narrative. Reflecting on how you would approach such a patient with depression can still be a learning exercise

In this virtual scenario there were some key areas that lead to a better understanding of the patient. The death of his mother was a trigger to his depression, depression can be a sequalae of the grieving process. You may also have picked up that he was worried about his own health, and possibly had somatic symptoms of abdominal pain. Such features are not uncommon in depression. Frequently, somatic symptoms may be the only presentation of depression. It is possible he had undiagnosed depression when he presented with the abdo pain 4-5 months ago.

Simon had biological features of depression with loss of appetite, early morning waking, loss of enjoyment of usual activities (anhedonia) diurnal variation of mood and lethargy. Work was also a key stressor an offer of timeout from work may be therapeutic to such patients. It is always important to consider suicide risk in any patient with depression, and to ask them specifically about this. Simon was at low risk although he had had suicidal ideation this was no longer present, he had not formulate a clear plan (vague mention of paracetamol), and had protective factors of his family.

You may have asked about some of these things and did not receive the answer you expected, rephrasing questions will train the simulation to give a more appropriate response next time and for other students

Virtual OSCE

See how you score on a virtual CCA. The questions are styled on a Yrs. 1-2 checklist format. (domain based CCA scoring of subsequent years would be more ideally suited to such a topic).

Further Reflections

How would you approach a history with a real patient, would you ask any questions differently and why

Some GP practices now have text discussions with patients, what do you see as advantages and disadvantages of such systems