Simulated Patient Brief — JO (Asthma — third-party)
Location: General Practice. THIRD-PARTY consultation. History only. Answer in the negative to any specific question not covered below.
- Name
- Jo (parent). Patient is Bobbie, 14
- Age
- Jo is 40 years
- Opening statement
- “It is actually about my eldest Bobbie… but as you can see, he has decided not to join us today…”
Bobbie was meant to attend but refused at the last minute. Symptoms of coughing and wheezing for several months, starting ~6 months ago. Night cough about 3 times a week. When you check, Bobbie describes the chest as “a bit tight,” sounds wheezy, but downplays it and wants to be left alone. In similar episodes Bobbie says he just needs a minute or two to catch his breath.
Plays school football; coughing worse after training, especially in cold weather; sometimes pauses in training to catch breath. No cough or wheeze at rest in the daytime. If asked: dry cough, no sputum, no haemoptysis, no chest pain (only tightness when bad), no recent fevers or coryza.
Behaviour has changed. Bobbie does not want to continue in the football team — “couldn’t be bothered.” Agreed to come today then refused an hour ago: “it’s pointless, and you can’t make me. My lungs are fine!” “Bobbie rarely talks to me these days… like getting blood from a stone.”
Response to questions
- Open questions: give the full parental account of nights, sport and behaviour.
- Closed questions: only the specifics listed (dry cough, no blood, no fever, etc.). Do not invent extra medical detail about Bobbie.
Ideas: Bobbie likely has asthma — younger sister has asthma and the symptoms are very similar.
Concerns: You have smelt tobacco/cigarettes on his clothes. You wonder if this is related. At your wit’s end with the behaviour.
Expectations: Appreciate it is difficult without Bobbie. Hoping for an inhaler to try even if he is not here. Main hope is advice/support around the worrying behaviour.
- Bobbie: hay fever (antihistamine in summer only)
- Childhood eczema — “grown out of it”; no regular creams
- Cetirizine 10 mg once daily in summer
- No known allergies
- Younger sister (10) has asthma
- No other significant family history
Married; live with Bobbie, younger sister and spouse. You work in the local-council planning department. Bobbie at local secondary school — did well until the past 6 months; had wanted to study Law. New friendship group; evenings out; drop in grades. Uncertain whether he is smoking; becomes defensive if you raise it. No known partner. Spends most time in his bedroom. School has noticed he is more withdrawn; no reports of bullying or truancy; has refused the school counsellor.
Systems review: reply in the negative to any other symptoms.