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The GP asks the Practice Nurse to take blood samples from Sandy to test for:
- full blood count
- urea & electrolytes
- liver function tests
- thyroid function
- glucose
- HbAlc
The Practice Nurse also asks Sandy to do a Peak Flow test. This is a test that provides an objective measure of how his lungs are functioning. It is done as a routine check on individuals diagnosed with asthma. Sandy’s peak flow readings are significantly reduced compared to the last readings taken. The GP suspects that Sandy is suffering from heart failure, however, he needs to ensure that Sandy’s breathlessness is not caused by poor control or deterioration in his asthma.
The GP explains to Sandy that he would like to discuss his case with medical staff at the nearest acute hospital and tells Sandy that he will contact him once he has done this. He tells Sandy about the Cash in Your Pocket scheme that is available in to individuals living in the area and to which Sandy can apply to for financial support to pay for his visits to the various clinics he needs to attend. Sandy agrees this seems a good idea and the GP fills out a referral form for him.
Scene 1
GP: Hello, Sandy. It’s a wee while since I last saw you. How are you?
GP thinks: Sandy is looking a bit unwell. He’s not a good colour.
Scene 2
SANDY: I just don’t feel very well, doctor. I’ve been a bit breathless and sometimes I’ve been getting palpitations – a couple of times at work recently, I’ve had to have a seat until I get back to normal.
Sandy thinks: It’s happening a lot but I’ll not mention that to the doctor, incase he makes me go to hospital. I can’t afford to have any time off work.
Scene 3
GP: Have you been at the asthma or the cardiac clinic recently, Sandy?
GP thinks: I wonder if Sandy has been taking his medications. Not sure if the breathlessness is his asthma playing up or the early stages of heart failure. I don’t suppose he’s been attending the diabetic clinic, either.
Scene 4
SANDY: No…the clinics always seem to be when I’m working and I can’t afford to take time off to travel all the way in to Aberdeen and back.
GP: I see you’re on quite a lot of pills and inhalers at the moment. Have you been managing to take your medication?
GP thinks: Sandy hasn’t had any repeat prescriptions for quite some time. It looks to me as if he isn’t taking his medications.
Scene 5
SANDY: Oh, yes, doctor, I always take my inhalers and pills.
Sandy thinks: I keep forgetting to take the pills – there’s too much to remember. My inhalers ran out ages ago but I haven’t quite got round to getting them replaced.
Scene 6
GP: And how are you getting on with cutting back on the drink and the smoking? It must be difficult when you’re working in the pub.
GP thinks: I doubt very much if Sandy has cut back on either since the last time he was here.
Scene 7
SANDY: Och, well, you know, I still like to have a pint with the lads, now and again, but I’m not drinking anything like I used to. And I’ve cut right down on the cigarettes.
Sandy thinks: I think I’ll just keep quiet on this one! And he doesn’t need to know about my cannabis habit – it helps relax me and makes me feel better, so I certainly don’t want to give it up.
Scene 8
GP: Let’s have a look at you then, Sandy, see if we can’t find out what is causing your problems.
GP thinks: I’m going to do a ‘full M.O.T.’ on Sandy, while I have the chance – who knows when he’ll turn up at the health centre again!
Scene 9
The GP carries out a full assessment on Sandy. He suspects that Sandy has a degree of heart failure, in addition to his other conditions.
The Practice Nurse has already recorded Sandy’s:
- Pulse – Sandy was slightly tachycardic, with a pulse rate of 97. This could be an indication that his heart is having to work harder to pump blood round his body.
- Blood pressure – Sandy is hypertensive, with a BP of 164/90 (Stage 2 Hypertension)
- Respiratory rate – Sandy’s respiratory rate is raised at 28 breaths per minute
Page last reviewed: 25 Sep 2020
