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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please consult with Bill Ferguson, who wants help in giving up smoking.

Scenario

Bill Ferguson is a 60-year-old carpenter. He has smoked 30 cigarettes per day since leaving school at the age of 14. Yesterday he was diagnosed as having had a transient ischaemic attack. The doctor at the Emergency department told him that he had to stop smoking.

Bill has come to see you today to ask for advice about stopping smoking. He has previously resisted any discussion about giving up smoking whenever he attends for regular blood pressure and cholesterol checks.

The following information is on his medical record:

  • Past medical history

  • Hypertension five years

  • Hypercholesterolaemia three years

  • Medication

  • Perindopril 5 mg od

  • Atorvastatin 80 mg per day

  • Aspirin 100 mg per day

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Family history

  • Father died of a stroke, aged 64

  • Mother aged 93, moderate dementia living in a nursing home

  • Social history

  • Smokes 30 cigarettes per day

  • Alcohol intake—not known.

INSTRUCTIONS FOR THE PATIENT, BILL FERGUSON

You are a 60-year-old carpenter. You have smoked 30 cigarettes per day since leaving school at the age of 14. Yesterday you had a funny turn. You suddenly could not use or feel your right arm and right leg. It only lasted about five minutes but it scared you and you went to the hospital. The letter from the hospital said it was a transient ischaemic attack or ‘ministroke’. The doctor at the Emergency department told you that you had to stop smoking or you may have another attack or even a full stroke. Additionally, you could lose your driving licence.

You have come to your usual GP for advice on stopping smoking. You have previously resisted any discussion about giving up smoking when you come for regular blood pressure and cholesterol checks.

Lighting a cigarette has been the first activity of your day for over 40 years. You have tried to give up smoking before by going ‘cold turkey’ and only stopped for two weeks. You have never tried nicotine replacement therapy or tablets. Yesterday’s funny turn has petrified you and you are now willing to do anything the doctor suggests.

The following information is on your medical record:

  • Past medical history

  • Hypertension five years

  • Hypercholesterolaemia three years

  • Medication

  • Perindopril 5 mg od

  • Atorvastatin 80 mg per day

  • Aspirin 100 mg per day

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Family history

  • Father died of a stroke, aged 64

  • Mother aged 93, moderate dementia living in a nursing home

  • Social history

  • Smokes 30 cigarettes per day

  • Alcohol intake—not known.

SUGGESTED APPROACH TO THE CASE

Introduction

Establish rapport and confirm reason for consult

Use the 5 A’s...

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