Case 66: Ali Turnbull

INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history and negotiate a management plan with Ali.

Prior to seeing you she completed the new patient questionnaire as below:

• Past medical history

• Recurrent tonsillitis

• Medication

• Nil

• Allergies

• Nil

• Immunisations

• Can’t remember, will ask Mum

• Cervical screen

• Normal two years ago

• Family history

• Mum and Dad both fine, live interstate

• Social history

• Artist

• Single

• Smokes 15 cigarettes per day

• No recreational drugs.

INSTRUCTIONS FOR THE PATIENT, ALI TURNBULL

You are a 32-year-old artist who has come to the GP to request sleeping tablets. You used to combine your artwork with work as a Community Development Officer at the downtown youth centre. This year you sold enough paintings to be able to afford to paint full-time. You love the freedom and chance to express yourself and are happy to be earning enough money doing what you love to do.

Your timetable is flexible enough to fit around your inspiration to paint and you often end up painting all night if you are working well. You fit shopping, washing and cleaning in between painting sessions, sometimes taking your work outside for more inspiration. You drink about eight cups of coffee per day and do no regular exercise. You drink two to three beers a day. Your ideal evening is painting until late and then catching up with friends on social media from the comfort of your bed.

Your mood is stable and you have no weight loss or other symptoms suggestive of an organic illness.

The only frustration is that you cannot sleep and you have decided to see if the local GP can help. This is your first visit to this practice as you previously saw the GP near the youth centre.

Before seeing the GP you completed the new patient questionnaire as below:

• Past medical history

• Recurrent tonsillitis

• Medication

• Nil

• Allergies

• Nil

• Cervical screen

• Normal two years ago

• Immunisations

• Can’t remember, will ask Mum

• Family history

• Mum and Dad both fine, live interstate

• Social history

• Artist

• Single

• Smoke 15 cigarettes per day

• No recreational drugs.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Open-ended questions to establish Ali’s ideas, concerns and expectations.

Specific questions¹

Sleep pattern and quality, bedtime regime

Lifestyle

• — Work

• — Family or community commitments

• — Alcohol and other drugs

• — Smoking

• — Exercise

General health

• — Brief systems review to exclude organic illness

  ...