INSTRUCTIONS FOR THE DOCTOR
Please conduct this consultation as you would in your clinical practice.
Jacinta Jones comes in to see you to discuss Natalie, her six-year-old daughter. She had taken Natalie to a paediatrician because her asthma was not well controlled on her medication of prophylactic cromoglycate and salbutamol.
You have read the letter from the paediatrician suggesting that Natalie start on inhaled steroids. You are not quite sure why she has booked this appointment to see you today, particularly as she did not come to see you about Natalie before going to the paediatrician.
INSTRUCTIONS FOR NATALIE’S MOTHER, JACINTA JONES
You are an articulate business executive in your late thirties. You live in a large house in a prestigious area of Sydney and travel a substantial amount for work. Natalie is your only child and you had her ‘later on’ so that you could establish your career first. Your husband is also in business and leaves the child care arrangements to you.
Natalie is six years old and has asthma. You are often up at night when she coughs and this is exhausting for both of you. Natalie uses a salbutamol inhaler and cromoglycate as a preventer. You recently took Natalie to see a private paediatrician about the asthma. You did not ask your GP for a referral and just paid the full price. You have precious little time for appointments and a friend’s child sees a paediatrician for their asthma so you thought it would be best.
You are concerned that the paediatrician has decided to start Natalie on steroids. You know they are banned in athletes and do not understand why they are being given to Natalie. You have made an appointment to see the GP and have the following questions on your mind:
Why has Natalie been recommended steroids? How do they work?
Is there any alternative medication that could be tried?
How will the GP know if the medication is helping Natalie?
Are there any side effects to worry about?
The paediatrician gave you a spacer for helping Natalie use the medication. You didn’t take in the instructions after a sleepless night and would like to be shown again.
SUGGESTED APPROACH TO THE CASE
Open-ended questions to establish Jacinta’s ideas, concerns and expectations about this consultation and Natalie’s asthma
Answer Jacinta in terms that are understood, in a non-judgemental manner.
Explain that asthma is due to inflammation. Steroids are anti-inflammatory and will reduce the amount of wheezing and coughing and make it easier for Natalie to breathe.
Explore why Jacinta is concerned about steroids: what has she heard about them and from whom? Tailor further answers about steroids ...