Role play Rhea Jones
35 year old medical secretary. Married, no children
You were completely well 4 years ago. At that time you started developing back problems – you took a
short course of pain killers and changed your office chair. That helped but then the pain came back 3-4
months later. On this occasion you tried physiotherapy – some posture techniques but even that did not
help.
You took pain killers again but soon they stopped being effective. Within months, you also developed pain
in your wrists and then your calves and thighs. Over the last 2-3 years the intensity of pain has remained
the same, occasionally getting worse despite trial of different medications and assorted complementary
therapies including aromatherapy, Chinese medicines etc.
Over the last 10 months- you have started getting very tired. Most days you were returning home to go
straight to bed. You don’t really exert at work and even rest does not alleviate your tiredness. You have
stopped going to the gym and over the last 6 months you have cut out most physical activities but without
much relief. You have been off work and are very worried about not being able to work again.
The lack of progress with treatment has frustrated you. You are very hopeful about seeing the new
specialist. You do not know that he is a psychiatrist and are really upset if and when this is revealed.
You volunteer the following information when requested
Medical History: No significant medical illnesses. Sore throat now and then and tender lymph nodes. You
have been investigated extensively – blood tests – blood count, thyroid function tests, immune profile,
CRP, ESR, EMG(elctromyogram) etc are all normal. You have tried various pain killers. No other
medication.
Psychiatric history: If asked you do admit to feeling frustrated- occasionally even tearful- but only
transiently. You enjoy going out but don’t do it because of tiredness.
Sleep, appetite: OK. Occasionally, again fleetingly, you have wished that you were dead but have no
ideas of self harm.
Family History: Parents in their 60’s – you get on well with them though you feel that they don’t believe
you are really ill. Brother is much more supportive and in fact often does your shopping for you. No family
history of any medical/psychiatric illness
Social History: Social network is dwindling. You live with your husband in your own house. Financially OK
but now worried that you may have to claim DLA or incapacity benefit to pay the bills.
Drug/Alcohol: Experimented with cannabis in the past. No other drug use. Social drinking non-smoker
Personality: You are quite a perfectionist- like to keep a tidy house but otherwise jovial and sociable. You
do read a lot of health journals and watch health programmes on TV and follow the reports on the net.
When discussing treatment- you are willing to try anything that will work but do get upset when
psychotropics or therapy are suggested. You want to know why and how they would work. You also feel
that your symptoms are not being taken seriously. You get upset with your partner when he seems to go
along with the psychiatrist. On the whole, however, you are reasonable and if the specialist can convince
you of a treatment you are willing to go along. However, if you feel patronised you get angry and upset.
Carer’s vignette
You are Dave, Rhea’s husband. You have been perplexed by Rhea’s symptom. You have wondered
whether she has a psychiatric problem and if/when you realise you are consulting a psychiatrist you are
pleased. You just want her problem to be sorted as you feel that Rhea has already spent a lot of
effort/energy and money to deal with the issue.
Sometimes, you have doubted whether her symptoms are real but feel guilty for feeling like that. You
disclose this to the specialist when asked.
Apart from that you want to ask the following questions
Will she get better?
What is actually the matter with her?
You have come across the term somatisation and you wonder whether your wife is somatising.
Finally, you wonder whether this could be something to do with her not wanting children.