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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Latu’s mother Mele. The findings of a relevant physical examination will be available from the facilitator. Negotiate a management plan with Mele. You are not required to take a history from Latu.

Scenario

Mele and her 11-year-old son Latu have been coming to your surgery since they moved to the area three years ago. Mele’s ex-husband, Robert, moved interstate after their marriage ended. Mele is from Tonga and her parents live nearby. She works as a receptionist for the local council and has another part-time job as a cleaner. Latu has previously been healthy, presenting only for minor illnesses. Mele presents today to discuss her concerns about Latu’s increasing weight and sedentary lifestyle.

The following information is on Latu’s summary sheet:

  • Medication

  • Nil recorded

  • Allergies

  • Nil recorded

  • Immunisations

  • Up-to-date

  • Social history

  • Lives with his mother

  • Attends school.

INSTRUCTIONS FOR THE PATIENT’S MOTHER, MELE KAFOA

You and Latu have come to the doctor today to get some help with his weight. Latu is 11 and generally healthy, but since you moved to this area his weight has been steadily increasing. He is less physically active and you have talked to him several times about getting more exercise and eating better, but each time he reacts angrily and tells you to stop nagging him. What motivated you to bring him in was an episode last week when he was upset and told you about being bullied at school about his weight. Latu is naturally shy but increasingly he has been withdrawing into his computer gaming world, which seems to be the main place that he is happy and engaged.

Your break-up with Robert was very unpleasant and you were glad to make a new start with Latu when you moved back to the area where your parents live. Unfortunately, Latu hasn’t really made good friends here, preferring to play online games with some of his previous friends. He goes to stay with Robert roughly one weekend a month and for some school holidays. From your point of view, Robert seeks to ‘buy’ Latu’s love by giving him lots of presents (computer games, tablet, new phone) and basically letting him do what he wants when Latu is with him. You feel that this undermines your efforts to help him be healthier but haven’t spoken to Robert about it. You would like to see Latu get outside more, play sport and be socially active but you’re having trouble reaching him. You are conscious that this role would normally be performed by Latu’s brothers or cousins, but in their absence you are doing the best you can.

You work hard both as a receptionist and a cleaner and are often not home until dinner time. You lack the energy ...

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