COPD: Storyboard

 

Cyril Lambert, 60, sees his wife’s family physician, Dr. Martin, for the first time in over four years.  To this point in his life, Cyril has rarely gone to the doctor but over the last two years he has been suffering from a persistent cough with intermittent episodes of shortness of breath.  Dr. Martin takes the opportunity to very carefully review the history of present illness, as well as Cyril’s past medical, family and social history.  He discovers Cyril has a 45 to 50 pack-year history of smoking.  Upon completion of the examination, Dr. Martin’s presumptive diagnosis is COPD (chronic obstructive pulmonary disease).  He orders a chest x-ray and refers Cyril for pulmonary function tests.  He prescribes a short-acting B2 agonist inhaler and councils Cyril to stop smoking.  Dr. Martin records the findings of this visit as a chart note in his EMR and creates a health profile for Cyril.

 

That day, Cyril goes to the pharmacy and purchases his inhaler.

 

Cyril also goes to the DI department of the local hospital and gets his chest x-ray done.  The radiologist views the image later that day and creates a report indicating findings consistent with COPD.

 

Three weeks later, Cyril attends his appointment for pulmonary function tests at the hospital outpatient department.  The test is interpreted the next day by an internist who finds evidence of obstructive airway disease.

 

Unfortunately, Cyril really enjoys smoking and is not convinced it is related to his breathing problems.  As a result, he continues to smoke.  He finds the inhaler difficult to manage so he rarely uses it.  A few months later, Cyril develops an upper respiratory tract infection (URTI).  His cough and breathing worsen significantly so he returns to see Dr. Martin who prescribes an antibiotic and two types of inhalers.

 

Cyril goes to a different pharmacy than he used previously but only gets the antibiotic prescription filled.

 

Ten days later Cyril is in a small town in a neighbouring province visiting family.  His breathing and cough have not improved so he goes to a local family physician, Dr. Smith.  Cyril is a poor historian so Dr. Smith accesses his records to obtain a list of his five most recent encounters with the health system.  Using this information along with her own examination, Dr. Smith feels there is bacterial resistance to the antibiotic prescribed, along with non-compliance using the inhalers.  She prescribes a different antibiotic and counsels Cyril on using his inhaled medications.

 

Encounters

• 1.1.1  New Family Physician Visit

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