GP Stage 3 Simulated Consultation - Patient 11
Your next patient is Janice Jeffrey. Janice was recently discharged from hospital after an admission with a lower respiratory tract infection. You last saw Janice two weeks ago where you recall she was extremely ‘wheezy’. Janice is an ex-smoker with a background of COPD..
You are Janice, a 67 year old patient who was recently discharged from hospital. You have arranged an appointment with the GP on the request of the hospital. You are feeling generally well with no respiratory symptoms although you would like to discuss the steroid medication prescribed by the doctor prior to your admission.
The hospital doctors advised that the GP’s steroid prescription negatively affected your immune system making you more susceptible to pneumonia. As such, you feel that the GP is to blame for your pneumonia and hospital admission, and you would like accountability for this ‘foolish error’. You are concerned about the clinical safety of this doctor, and do not feel that they should be seeing patients.
Additionally, you also recall that it was this doctor who advised you to stop smoking in a previous consultation, and you are now questioning the rationale behind that advice as well. You would ideally like the doctor to arrange a meeting with a more senior colleague to investigate this prescription and the overall safety of this doctor’s practice. You would also like a written apology as well as a course of antibiotics in case you have a recurrence of your wheezing symptoms so that you do not have to attend the GP surgery or hospital again.
At home, you live with your 75 year old bed bound husband. Your son was able to look after your husband during your recent admission, although your son’s work commitments mean that this will likely not possible in future. You do not have any social care or funding support to assist with your husband’s welfare.
This case highlights the challenges of patients receiving care from multiple clinicians. It is likely that the patient’s symptoms have been misreported to the hospital, or the patient has misunderstood the opinion of the hospital clinician given the generally acceptable prescription of steroids in a wheezy patient with COPD. Nonetheless, it is appropriate to apologise to the patient for the potential error and agree for this to be investigated further given the patient’s request. A written apology and acceptance of incorrect practice would not be appropriate at this stage. A wider social history should not be ignored in order to establish Janice’s home challenges and scope for additional support.