"I am sorry to trouble you doctor but I'm not feeling very well at all, I am feeling quite short of breath"
Clinical Details
Open questions — give freely:
Sudden onset shortness of breath started about an hour ago while out shopping. At the checkout when it began; finished paying, sat in the café, but the feeling persisted.
Discomfort in the chest just below the bra strap — comes and goes.
Generally feeling unwell, a bit dizzy and “off” — thinks this may be anxiety about the breathing.
Only if asked directly:
No fever, cough, sputum, palpitations or haemoptysis
Chest pain worse on deep inspiration (pleuritic)
Just returned from the South of France (holiday home) — 14-hour drive yesterday
On getting back noticed discomfort in one calf; thought it was from sitting so long
Patient Perspective (ICE)
Ideas: No idea what is causing it but worried.
Concerns: Feeling really out of sorts; worried.
Expectations: Doctor to tell you what is wrong or what you need to do.
Past Medical History
Tonsillectomy 1987
Acne rosacea 2010
Medication
Kliovance tablets for 2 years (HRT)
Family History
No relevant family history.
Social History
Ex-smoker — 10 pack-year history; gave up 20 years ago
Alcohol — a couple of glasses of wine with dinner most nights
Lives with husband (out playing golf today) and 1 dog; 2 grown-up children
Writer / journalist; time split between house here and in France
Simulated Patient Behaviour
Speaking in reasonably long sentences but visibly a bit short of breath
Shocked if hospital is suggested but agrees
Worried about who will get the dog — agree to phone neighbour
Offer to drive yourself but agree to ambulance if offered
Information for the Student
Name
Rachel Green · Age 52
PMH
Tonsillectomy 1987 · Acne rosacea 2010
Medication
Kliovance (HRT) 2 years
Recent
This year: annual HRT review — well, BP 120/70, BMI normal, continue. Last year: HRT review — hot flushes stopped, breast aware, continue. May 2018: solar lentigo — advice, sunscreen