Simulated Patient Brief — SAM (ILD)
Location: General Practice. History only — no examination. Answer in the negative to any specific question not covered below.
- Name
- Sam
- Age
- 62 years
- Opening statement
- “My spouse sent me in — this cough has been going on for months and I’m more breathless.”
Spouse finds the cough extremely annoying. It has lasted 3–4 months; you thought it was irritation after a virus — “people seem to have coughs for a long time after Covid.” Dry cough — rarely brings anything up. A couple of chest infections that cleared quickly with antibiotics.
For maybe a year you have not been as fit; you brush this off as age and work. If asked specifically, you stop for breath every couple of hundred yards; ten years ago you could walk miles. Not particularly breathless at night; only when active. Sleep on 2 pillows as always. Tired earlier in the day; sometimes nap at work.
Fingertips have got massive and nails have curved around them. Do not weigh yourself but a couple of months ago had to go in a loop on your belt.
Response to questions
- Open questions: downplay the cough and fitness change; mention spouse pressure.
- If asked specifically: dry cough; clubbing description; belt tighter; 2 pillows; occupational history as below. Never knowingly exposed to asbestos dust.
Ideas: Just a cough that has stuck around too long, and you are getting old.
Concerns: Not worried about anything medically significant. Spouse is worried about lung cancer, which you think is stupid because you have never smoked. A little worried about taking it easy at work because people look up to you.
Expectations: Chest X-ray to reassure your spouse. Maybe cough syrup — pharmacy remedies have not helped.
- Rarely saw a doctor until a year or so ago
- A couple of recent chest infections that cleared quickly
- Hypertension and high cholesterol ~10 years — well controlled
- Ramipril; atorvastatin
- No known drug allergies
- Dad died ~20 years ago from lung cancer
- Mum alive, frail with dementia, care home
- No other known familial conditions
Proud local business owner for over 30 years since leaving the army. Bespoke kitchen worktops in marble and quartz — offer to make one for the student’s kitchen. Worked up from manufacturing and fitting. If asked about PPE, act offended — everything is to the highest standard now; 30 years ago there was no protective gear. Smoked a couple of years in your 20s; did not like it. Happily married 30 years; live with spouse on the outskirts of town.
Systems review: reply in the negative to any other symptoms.