MCLEAN · Crohn's Flare

Patient Details

Name: John / Joan McLean
Age: 48 years
Opening statement: "Hi doctor, I am just wanting to get my Crohn’s under control"

Facilitator Notes

Stable Crohn’s with current flare — patient not forthcoming; students must extract information
Key concern: hospital admission would harm business (mobile burger van “Fry Hard”)
Manage expectations around next steps; involve wider team (IBD specialist nurses etc.)
Resource: NICE CKS – Crohn’s disease (confirmed)

Clinical Details

Open questions — give freely:

4 episodes of loose motions every day for the last 3 weeks. Sometimes wakes from sleep and has to rush to the toilet.

Only if asked directly:

Blood mixed with stool
Constant lower abdominal pain, especially right lower quadrant
No nausea/vomiting · No fever · No weight loss (appetite reduced but drinking well; more thirsty)
Passing urine normally · No recent travel · No unusual food (only takeaway from own van — exemplary hygiene)
Under gastroenterology for years; last consultant review 2 years ago (missed last annual appointment due to work)
Diagnosed 10 years ago (after birth of second child). Flare 8 years ago treated with mesalazine + oral prednisolone (high dose then weaned). Always compliant

Patient Perspective (ICE)

Ideas: Probably the Crohn’s flaring.

Concerns: Really worried about going into hospital — would be a great detriment to the business (already in financial trouble).

Expectations: Medication for the flare — would like what was given last time.

Feelings: Worried about business and supporting young family.

Past Medical History

Crohn’s disease — diagnosed 10 years ago (previously stable)

Medication

Mesalazine 2 tablets three times daily
No known drug allergies

Social History

Owns mobile burger van (“Fry Hard”) in lay-by off M1 near Milton Keynes — regular drivers expect early opening
Married; children 10 (boy) and 12 (girl)
Smokes 20/day · Alcohol 10–14 units/week (gin)

Demeanour

Closed with answers — man/woman of few words after opening statement. Answers only what is asked; not aggressive or elusive. Will not be persuaded into hospital if avoidable.

Physical Examination (only if requested)

BMI 24 · Temp 36.8 · Pulse 90 · RR 18 · SpO₂ 100% RA · BP 125/75
Abdomen: soft; no organomegaly/masses; tenderness RIF; no guarding; bowel sounds normal; no palpable nodes

Information for the Student

Name: John / Joan McLean · Age 48
PMH: Crohn’s disease diagnosed 10 years ago — now stable until current flare
Medication: Mesalazine 2 tablets TDS
Recent: 2 years: otitis externa (Otomize) · 4 years: new patient check

Primary Care Block · University of Buckingham