Week 1

S: 22 year old female presenting with a three month history of thoracic spine pain. The patient has a history of lower back pain, and was currently unemployed as a result. The presentation consisted of constant thoracic spine pain, pain with coughing, and night pain. The patient has no other relevant past medical history.

T: Perform a subjective, objective and appropriate treatment.

A: After taking the subjective history, there were obvious red flags. I did not wish to proceed further with any objective examination or treatment as I did not feel it was appropriate. Instead, I advised the patient to go back to her GP and seek medical advice on the situation and suggested a scan may be appropriate at the doctor's discretion.

R: The patient agreed to my advice. I wrote a letter to the patient's doctor with the subjective examination findings and the suggestion that further investigation may be appropriate. I am unsure as to the result of these at the current time.

E: I was quite nervous once hearing the subjective history, as this was the first time I had encountered 'red flags'. I also did not want to appear as though there was major concern and I think I kept proffessional during the session. I feel I expressed my concern for further investigation in a calm proffessional manner, and not to worry the patient.

S: I seeked advice from my supervisor following the subjective, although he left it to my discretion. I told him I would refer the patient back to the GP and he agreed that was the appropriate decision. He did ask me to complete an objective examination, although it would be limited.