You may write your notes in the fields below as the dialogue unfolds, or at the end. When finished, please click the blue, arrow button to complete the entry. Only click this button when you are completely finished with your note and trainee feedback.
Prompt: Imagine that you are observing an in-person trainee-patient interaction through a live video feed. Please enter observational notes about the clinical interaction from whatever perspective you most often hold in clinical interactions—e.g. as a clinician/educator writing a chart note, as a patient/family member note-taking, etc.
Background: This patient is known to the supervising physician. He is a 21 year old male with a history of asthma. The physician delivered him as a baby. He doesn’t come into the clinic too often and his last visit was 5 years ago. The reason for his visit, as listed on the appointment sheet is “prescription renewal.”
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Trainee: Hi James, my name is Chris and I’m a senior medical student working with Dr. S today. I’m going to take your history and do a physical exam, and then I’ll review with Dr. S who will finish the visit with us. Does that sound ok to you?
Patient: Yeah sure no problem, I’m used to meeting you med students all the time.
Chris: Great - thanks. So, what’s bringing you in today?
James: Uh I just need my asthma inhalers refilled. I asked the pharmacy to refill it but they said I needed to see my doctor because the last prescription they had was old.
Chris: Ok, yes, I see that you last had your inhalers filled about 5 years ago! Have you been getting them elsewhere?
James: No. I don’t go to any other doctors, just here.
Chris: Ok, no problem. If it’s ok with you, I’m just going to ask some questions to understand the issue a bit better. Is that ok?
James: I guess. I mean what do you need to know? I have asthma. I have inhalers. I would like them to be refilled. Doesn’t seem like rocket science to me.
(Chris seems unsure of how to proceed. He looks nervous and uncomfortable.)
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Chris: I understand. We’ll make sure to do this as quickly as possible, but it’s important to understand how your asthma has been since we last saw you. So, can I ask why you need your inhalers now, after not needing them for 5 years?
James: I recently got a cat and I’m having more coughing and wheezing at home when I’m around him. I guess I’m allergic to him, or he’s stirring up my asthma or whatever.
Chris: Ok, I see. What’s your cat’s name?
James: His name is Bob.
Chris: How often are you wheezing?
James: Whenever I’m around him. So I guess every day.
Chris: Do you have shortness of breath?
James: When I’m wheezing, yes.
Chris: Do you ever wake up in the night with trouble breathing or coughing?
James: Not too often - maybe once or twice a week.
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Chris: Before you got Bob, how was your asthma?
James: I still had wheezing and coughing but it was less often, maybe a couple times a week
Chris: Do you know what triggered it in those instances?
James: Probably weed.
Chris: Oh, you smoke.
James (appears shocked and a bit taken aback): Yes, I smoke weed. It’s legal, doc.
Chris: Right, yes, it’s not that I was questioning that. Just that, well, it can be really bad for people with asthma to smoke. So I don’t think it’s just the cat that’s causing your symptoms.
James: Yeah I guess it probably contributes to it, but I can manage ok. It really only got bad with the cat.
Chris: Ok, I’m going to ask some more questions now. Do you smoke cigarettes?
James: No
Chris: Do you do other drugs?
James: No. Why are you asking me all of this? Just because I said I smoke weed?
Chris: No, sorry, we ask these questions to everyone. But I also need to know about other things that might cause your asthma. Do you have any allergies?
James: No, no allergies.
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Chris: Do you take any medications?
James: Just the inhalers, if I had them.
Chris: Have you ever been hospitalized because of your asthma?
James: No, never.
Chris: Do you have drug coverage for your inhalers?
James: Yeah, through my University
Chris: Oh! You’re in University! Wow, what do you study?
James: I’m in my last year of engineering.
Chris: That’s amazing - good for you.
James: Yeah, thanks. Anyway, would we be able to fill that prescription now?
Chris: Soon. I just want to first do a quick physical exam - is that ok?
James: Sure.
(Chris checks James’ blood pressure, heart rate, oxygen saturation and performs a cardiovascular and respiratory examination.)
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James: So…are we ready for that inhaler now?
Chris: It does sound like you need your inhalers, and I’m glad you came in today so we can help you manage your asthma. I agree that your cat is probably making your symptoms worse, but I think your smoking is honestly the main issue. You really need to stop smoking. I also bet you could do even better in your program without the weed - you know it can impact your concentration and memory.
James: Thanks for the tips. I’ll think about it (he rolls his eyes).
Chris: Great - I’m glad you’ll think about it. I think I’ll hand it over to Dr. S now to wrap up and provide you with your prescription. Thanks so much for taking the time to talk to me today!
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Please complete your chart note and any debriefing comments for Chris in the fields below.
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