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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Jonty and his father, Matt. The results of a focused physical examination will be available on specific request from the facilitator. Outline the most likely diagnosis to Jonty and Matt and discuss your suggested management plan with them.

Scenario

Jonty McLeod is 12 years old. Following his parents’ divorce, he spends half his time with his mum, Elspeth, and half with his dad, Matt. Jonty has mild persistent asthma, which is well controlled with inhaled corticosteroids.

The following information is on Jonty’s medical record:

  • Past medical history

  • Asthma

  • Medication

  • Fluticasone 100 mcg bd

  • Salbutamol 200 mcg prn via spacer

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Family history

  • Mother has severe eczema

  • Social history

  • Attends high school.

INSTRUCTIONS FOR JONTY AND MATT

Jonty

You are 12 years old. You are quite settled in the routine of spending half your time with your father, Matt, and half with your Mum, Elspeth. You enjoy being in your Mum’s city flat, which has a nearby cinema and ice-cream shop. Time with your Dad is also enjoyable but more chaotic, as his house is packed with half-finished custom-made furniture, plus his ever-loyal, kelpie-cross Homer.

You have had asthma since you were a baby and it is well controlled. For the last few months you have noticed it has been worse when you are at Dad’s and you also seem to sneeze a lot. Your nose is often itchy, runny and blocked, so that you can find it difficult to sleep.

You are in grade seven at a school half-way between Mum and Dad’s and are generally a happy kid. There are no problems at either home or at school, other than finding blowing your nose all the time annoying and embarrassing!

Matt

You are a self-employed carpenter. Your marriage to Elspeth fell apart because she wanted to live in the city, whereas you wanted a more relaxed country lifestyle. You have both been much happier since the divorce and Jonty seems to thrive on the variety of having two very different homes.

In recent months you have been nagging Jonty to blow his nose and often hear him sneezing and awake during the night. When you finally caught up with Elspeth after one of her overseas trips, you were surprised to find out that Jonty sleeps through when he is at her house and seems well most of the time.

You have now come to see your own doctor to plan what to do.

Note: If you are unable to persuade someone to play Jonty’s role, please change the scenario so that the consultation takes place with Matt on his ...

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