A 14 year old girl with poorly controlled asthma presents with her and her family asking what she can do to stop coughing all the time. They live close to the main road in town. You note on her medication history she has had 8 Ventolin pMDI inhalers and 2 Clenil pMDI in the last 6 months. They’re asking for more cough syrup.
A 36 year old male who has recently returned from Southern France now presents with a flu like illness. He describes feeling exhausted with a fever, rash and vomiting. He tells you he got bitten lots by mosquitoes when in Southern France, and feels just like on his gap year when lots of his friends got unwell in South East Asia.
20 year old old psychology student comes saying that she is not coping and worries about the climate and her / her family’s future. She’s thinking of stopping university as there is no point getting a degree if the world continues to get hotter. In the past she got very involved in eco activism but now she is thinking that there’s no point as big business and capitalism is so powerful. She is eating OK and sleep is 6 hours a night with some early waking.
An 80 year old man presents with sudden onset of one sided weakness of his face and slurred speech. He lives with his similarly aged wife in deprived neighbourhood. He has been on treatment with a thiazide and calcium channel blocker for hypertension. He was normally fit and well.
93 year old woman is living in a care home. She has severe vascular dementia and has had a previous stroke. Her swallowing is poor causing recurrent aspiration pneumonia. She is bedbound and has hoist transfers. She has been admitted to hospital for this, falls, and general deterioration / infections 5 times this year so far and 4 times last year.
She has a DNACPR form but no other advance care plan.
She is on 14 medications including antidiabetic medication, antihypertensives, anticholinergics, and statins.
68 year old obese man who has chronic pain from his osteoarthritis (on co-codamol 8/500 with some extra codeine at night) and depression (for which he’s on paroxetine), chronic reflux (which cimetidine controls well) and dermatitis (for which he has betamethasone, oilatum and a nightly chlorpheniramine), comes as his ‘diet controlled’ Diabetes is no longer controlled and his friend suggests he should be on Metformin.
Resources for educators
If you would like to use these cases for teaching purposes please contact Greener Practice for access to a powerpoint and support in using this teaching approach. Cases and commentary written by Dr Mike Tomson (with support from Dr Hayley Pinto (Hopelessness) and Dr Veena Aggarwal (recurrent hospital admissions)) for Greener Practice