Briefing — read this before starting. The transcript will appear here once the consultation begins.
Doctor Notes
Patient Information
Name: Margaret Ellison
Age: 62 years
Gender: Female
Reason for Appointment
Recall appointment: routine methotrexate monitoring bloods flagged — ALT significantly raised. Margaret Ellison, 62, rheumatoid arthritis, shared care with rheumatology.
Medical History
Past Medical History
- Rheumatoid arthritis
- Hypertension
Drug History
- Methotrexate 15 mg weekly (Sundays)
- folic acid 5 mg weekly
- amlodipine 5 mg OD
Monitoring bloods (this week)
- ALT 118 U/L (<40) — baseline 20–35 for five years
- ALP 78 U/L (30–130); bilirubin 8 µmol/L (<21); albumin 41 g/L (35–50)
- Hb 131 g/L (120–150); WCC 6.6 ×10⁹/L (4.0–11.0); neutrophils 4.2 ×10⁹/L (2.0–7.5); platelets 302 ×10⁹/L (150–410)
- eGFR 74 mL/min/1.73m² (>90), stable
Shared care record
Shared-care agreement with rheumatology in place; advice line available. Last rheumatology review 5 months ago: "excellent control — continue".