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INSTRUCTIONS FOR THE DOCTOR

This is a long case.

Please take a history from Mrs Humphries. Then ask the facilitator for the results of the physical examination. Discuss your management plan with Mrs Humphries.

Alternative instructions

Medical students and junior doctors might learn more from this scenario if they are asked to conduct the physical examination and negotiate a management plan with Mrs Humphries without a time restriction.

Scenario

You are called to see Mrs Elsie Humphries, an 85-year-old woman, at home. Her family phoned for the visit because she has told them that she has had several falls recently. They run a business interstate and visit her twice a year. The family want reassurance that Mrs Humphries is safe.

The following information is on her summary sheet:

  • Current medical problems

  • Diverticular disease

  • Congestive heart failure

  • Atrial fibrillation (AF)

  • Past medical history

  • Burnt-out rheumatoid arthritis

  • First child 1959

  • Second child 1961

  • Medication

  • Warfarin as directed

  • Digoxin    0.625 mg od

  • Frusemide    20 mg od

  • Perindopril    5 mg od

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Social history

  • Widowed 2007

  • Husband was an Australian Football League coach

  • Non-smoker

  • Alcohol intake—two standard drinks per week.

INSTRUCTIONS FOR THE PATIENT, ELSIE HUMPHRIES

You are a rural battler. You have survived several droughts and floods and had rheumatoid arthritis during middle life. You are determined not to let old age beat you. You have coped since you were widowed and, while you do not enjoy getting old, you are proud of managing despite having only your cat for company.

You gave up expecting your children to be of any help to you long ago. They visit for just long enough to ease their guilt and run back to the city. If the children had their way they would parcel you up and put you in a home. It has worried them that you have mentioned a couple of recent falls. The children have asked your doctor to make a home visit to check that you are still safe.

You have fallen three times in your home in the past two months. The most recent fall was last week when you tripped over a door mat going to hang your washing out. You hit the side of your head on the door frame, but did not sustain any other injuries or lose consciousness. Your other falls have been similar. You have had no dizziness and are currently otherwise well.

You have noticed it is harder to see details on the TV, and you stopped buying the newspaper a couple of years ago when you couldn’t read the small print. You haven’t noticed any changes in your hearing.

You have given up driving and catch a taxi once per week to the local shops to buy your groceries, ...

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