Breathlessness

Question 1

Name

Answer 1

Jamie Stevens

Question 2

Age

Answer 2

45

Question 3

DOB

Answer 3

04/12/79

Question 4

Opening Statement

Answer 4

“I’m feeling a bit breathless and wonder whether it’s just my smoking that’s causing it or something else”.

Question 5

Symptoms, last couple of years (3)

Answer 5

• Mild breathlessness
• Cough
• Gradually getting worse, but not drastically so

Question 6

Symtoms - immediate (4)

Answer 6

• 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

Question 7

Not-symptoms (3)

Answer 7

• No pain in chest
• Not sweaty
• Not nauseous

Question 8

When out of breath and wheezy (4)

Answer 8

• Cough a bit
• deep breaths
• Relieves symptoms
• Clear phlegm

Question 9

My thoughts (2)

Answer 9

• Smokers cough
• Normally happens first thing in morning and when out with the dog

Question 10

Any recent change in breathlessness?

Answer 10

• Not really

Question 11

Any other symptoms at the moment? (3)

Answer 11

• Don’t feel ill
• Don’t have temperature
• Phlegm no different to normal

Question 12

Make sure you mention (3)

Answer 12

• Chest infections in the past
• One every winter for last three years
• Always ill before Christmas!

Question 13

Annual chest infections (6)

Answer 13

• 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

Question 14

Ever brought up blood?

Answer 14

No

Question 15

Chest pain?

Answer 15

No

Question 16

Hurt to take a deep breath in?

Answer 16

No

Question 17

Calf pain or swelling?

Answer 17

No

Question 18

Been immobile recently/

Answer 18

No

Question 19

Weight

Answer 19

Steady

Question 20

Feeling tired

Answer 20

No more than normal

Question 21

Swollen ankles?

Answer 21

No

Question 22

Need to sleep propped at night?

Answer 22

No

Question 23

Wake gasping for breath?

Answer 23

No

Question 24

Past medical background (2)

Answer 24

• Appendix taken out as child
• Bad Covid bout during Pandemic

Question 25

Medication?

Answer 25

None

Question 26

Allergies?

Answer 26

None

Question 27

Family history? (2)

Answer 27

- Dad died of lung cancer in his 70s (heavy smoker) - No other family history I'm aware of

Question 28

Home life (4)

Answer 28

- Live with partner and little dog - Two teenage boys - All fine - She's been nagging me to see a doctor

Question 29

Work (4)

Answer 29

- Taxi Driver - have done this all my life - Enjoy it - Never worked a job that would expose me to hazardous chemicals - Work late hours

Question 30

Been abroad?

Answer 30

Never

Question 31

Smoking (3)

Answer 31

- Started age 15 - Smoked until two years ago - Quit when dad got lung cancer

Question 32

Drink (2)

Answer 32

- social accessions - once a month

Question 33

Drugs?

Answer 33

Never

Question 34

Diet

Answer 34

- Generally quite healthy

Question 35

Exercise

Answer 35

- but don't get a lot of exercise - slow dog walks

Question 36

Patient ideas

Answer 36

- think it's a smoker's cough which will settle in time now I've stopped smoking

Question 37

Patient Concerns (2)

Answer 37

- Not overly worried - Partner worried it could be lung cancer

Question 38

Patient Expectations (2)

Answer 38

- To be told it's a smoker's cough that will get better with time - Maybe an X-ray to make sure

Question 39

Patient Impact

Answer 39

- Coughing in the taxi is a bit off-putting for clients!

Question 40

Patient emotions

Answer 40

- A positive person so not really letting it get to me - just a bit wary of lung cancer - annoyed with the cough

Question 41

Sc. 2: Background

Answer 41

- Come in for follow up. - Spirometry tests and a chest X-ray - No sign of lung cancer

Question 42

Sc.2: Question

Answer 42

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?

Question 43

Sc.2 Potential Questions

Answer 43

- What difference will stopping smoking have made? - What treatments are there? - Will I end up needing oxygen?

Question 44

Sc.2 Perspective

Answer 44

- Realise this is serious - Happy I stopped smoking - Happy to take further advice

Question 45

Sc.3 Background

Answer 45

- Not cross with the student, but with the treatment so far

Question 46

Sc.3 Questions (4)

Answer 46

- 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?

Question 47

Sc.3 Reaction to student trying to 'explain it away'

Answer 47

Get a bit surly and withdrawn. Not prepared to listen.

Question 48

Sc.3 If student colludes with you or offers to help you make a formal complaint in writing.

Answer 48

"Oh, it doesn't matter".

Question 49

Sc.3 Ideal student response (4)

Answer 49

- 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.