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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please respond appropriately to Dilip’s questions.

Scenario

Dilip Patel is a 44-year-old plumber who lives in your rural town. Four weeks ago he had severe chest pain while working and was admitted to hospital with acute coronary syndrome. Tests confirmed myocardial infarction and triple vessel disease for which he had coronary artery bypass graft (CABG) surgery in a metropolitan tertiary hospital. Dilip is now on the following medications:

  • Atorvastatin 80 mg od

  • Glyceryl trinitrate spray prn

  • Aspirin 100 mg od

  • Clopidogrel 75 mg od

  • Perindopril 5 mg od

  • Metoprolol 50 mg od.

The following information is on his summary sheet:

  • Past medical history

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Nil recorded

  • Family history

  • Nil recorded

  • Social history

  • Plumber

  • Ex-smoker.

INSTRUCTIONS FOR THE PATIENT, DILIP PATEL

You are a 44-year-old plumber in a rural town. Four weeks ago you had severe chest pain while working and you were admitted as an emergency to the local hospital. You were told that you had had a heart attack. After lots of tests you had urgent bypass surgery in a big city hospital.

You are now back home. On discharge from the hospital you were given a long list of medications to take. You have never needed tablets before and keep forgetting to take them.

You are unsure what the tablets are for as you assumed the bypass surgery cured the problems. You have all the tablets with you in a shopping bag in case the GP asks you what you are taking. You have the following questions for the GP:

  • why do I need to take tablets when the operation fixed the problem?

  • what does each tablet do?

  • how long will I be on these tablets?

  • do they have any side effects?

You take:

  • Atorvastatin 80 mg once per day

  • Glyceryl trinitrate spray as required for chest pain

  • Aspirin 100 mg once per day

  • Clopidogrel 75 mg once per day

  • Perindopril 5 mg once per day

  • Metoprolol 50 mg once per day.

You quit smoking 10 years ago and do not drink alcohol. You do no regular exercise.

Once the GP has discussed your worries about the medication you will be interested to hear any other advice the GP offers. If the GP starts to give other advice before answering your concerns about the medication you will get quite cranky and irritable.

The following information is on your summary sheet:

  • Past medical history

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Nil recorded

  • Family history

  • Nil recorded

  • Social history

  • Plumber

  • Ex-smoker

  • Alcohol—nil.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Explore Dilip’s understanding and concerns about his medication

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