Breathlessness Flashcards
Name
Jamie Stevens
Age
45
DOB
04/12/79
Opening Statement
“I’m feeling a bit breathless and wonder whether it’s just my smoking that’s causing it or something else”.
Symptoms, last couple of years (3)
- Mild breathlessness
- Cough
- Gradually getting worse, but not drastically so
Symtoms - immediate (4)
- Mild breathlessness and wheeziness when walking the dog
- Slowing down, a big cough, and a couple of deep breaths normally helps
- Don’t need to stop
- Otherwise don’t really notice it
Not-symptoms (3)
- No pain in chest
- Not sweaty
- Not nauseous
When out of breath and wheezy (4)
- Cough a bit
- deep breaths
- Relieves symptoms
- Clear phlegm
My thoughts (2)
- Smokers cough
- Normally happens first thing in morning and when out with the dog
Any recent change in breathlessness?
- Not really
Any other symptoms at the moment? (3)
- Don’t feel ill
- Don’t have temperature
- Phlegm no different to normal
Make sure you mention (3)
- Chest infections in the past
- One every winter for last three years
- Always ill before Christmas!
Annual chest infections (6)
- Feel ill
- Cough more
- Bring up green mucus
- Feel more breathless and wheezy
- Antibiotics sort it out
- Steroids last time were even better! Sorted the wheeze a beauty
Ever brought up blood?
No
Chest pain?
No
Hurt to take a deep breath in?
No
Calf pain or swelling?
No
Been immobile recently/
No
Weight
Steady
Feeling tired
No more than normal
Swollen ankles?
No
Need to sleep propped at night?
No
Wake gasping for breath?
No
Past medical background (2)
- Appendix taken out as child
- Bad Covid bout during Pandemic
Medication?
None
Allergies?
None
Family history? (2)
- Dad died of lung cancer in his 70s (heavy smoker)
- No other family history I’m aware of
Home life (4)
- Live with partner and little dog
- Two teenage boys
- All fine
- She’s been nagging me to see a doctor
Work (4)
- Taxi Driver
- have done this all my life
- Enjoy it
- Never worked a job that would expose me to hazardous chemicals
- Work late hours
Been abroad?
Never
Smoking (3)
- Started age 15
- Smoked until two years ago
- Quit when dad got lung cancer
Drink (2)
- social accessions
- once a month
Drugs?
Never
Diet
- Generally quite healthy
Exercise
- but don’t get a lot of exercise
- slow dog walks
Patient ideas
- think it’s a smoker’s cough which will settle in time now I’ve stopped smoking
Patient Concerns (2)
- Not overly worried
- Partner worried it could be lung cancer
Patient Expectations (2)
- To be told it’s a smoker’s cough that will get better with time
- Maybe an X-ray to make sure
Patient Impact
- Coughing in the taxi is a bit off-putting for clients!
Patient emotions
- A positive person so not really letting it get to me
- just a bit wary of lung cancer
- annoyed with the cough
Sc. 2: Background
- Come in for follow up.
- Spirometry tests and a chest X-ray
- No sign of lung cancer
Sc.2: Question
Is there anything to worry about on the chest x-ray? What are the results of the spirometry? The nurse said you’d need to discuss it with the GP – so you got the impression it might be something else?
Sc.2 Potential Questions
- What difference will stopping smoking have made?
- What treatments are there?
- Will I end up needing oxygen?
Sc.2 Perspective
- Realise this is serious
- Happy I stopped smoking
- Happy to take further advice
Sc.3 Background
- Not cross with the student, but with the treatment so far
Sc.3 Questions (4)
- Why has no-one ever mentioned COPD before?
- I’ve had ‘chest infections’ the last three years, have I been misdiagnosed?
- I was told before it was just infections, and now I’m being told it’s something else.
- Has this delay in diagnosis caused long term harm?
Sc.3 Reaction to student trying to ‘explain it away’
Get a bit surly and withdrawn. Not prepared to listen.
Sc.3 If student colludes with you or offers to help you make a formal complaint in writing.
“Oh, it doesn’t matter”.
Sc.3 Ideal student response (4)
- Listen to you and make you feel like you’ve been taken seriously.
- Feel reassured that I will have my concerns addressed
- Say they will discuss it with their clinical supervisor and ask them to discuss this with you.
- Allow you to have a proper conversation about this.
