INSTRUCTIONS FOR THE DOCTOR
You are expected to take a history from Brandon’s mother, Julie. Results of the examination will be available from the facilitator. Outline your differential diagnosis to Julie and negotiate a management plan.
Brandon is a lively two-year-old Caucasian boy. He has been a patient at the surgery since he was born and has attended only for coughs and colds, and immunisations. His growth has been along the 75th centile.
Four weeks ago, Julie brought Brandon in concerned that he had ‘gastro’. He had vomited three times in the night and had profuse watery diarrhoea. He was not dehydrated. You advised fluids and expected that the illness would soon resolve. Today Julie has come to see you because Brandon’s diarrhoea is continuing.
The following information is on Brandon’s summary sheet:
INSTRUCTIONS FOR BRANDON’S MOTHER, JULIE HARKNESS
You work as a pharmacy assistant three days a week and spend the other days at home with your children. Your daughter, aged four, attends preschool and Brandon, your two-year-old, attends child care.
Four weeks ago, Brandon had ‘gastro’. He was vomiting and had diarrhoea. The vomiting soon settled and, as advised, you continued with fluids and reintroduced solids when Brandon seemed hungry. He no longer has any fever.
Brandon is thriving with a good appetite and seems well but the diarrhoea has not stopped. He passes a light-coloured, loose, watery, foul-smelling stool about five times a day and you can see undigested food in it. Previously Brandon passed one to three stools per day. The situation is beginning to get you down because the staff at child care are worried about him and keep suggesting that he is not well enough to be there. When you talked with the pharmacist at work, she suggested you go back to the GP for a check-up.
The following information is on Brandon’s medical record:
INFORMATION FOR THE FACILITATOR
Clinical examination findings
Clinical examination is entirely normal. Brandon’s weight and height are on the 75th centile and tracking well.
SUGGESTED APPROACH TO THE CASE
Open-ended questions to explore Julie’s ideas, concerns and expectations.
Details about the episode of gastro
Details about the diarrhoea—frequency, smell, blood, colour, consistency, mucus
Current diet—any observed relationship between diet and diarrhoea