Patient Interaction: Discussing a Chesty Cough

So the following clip shows me consulting with a patient who’s coming in about a chesty cough. Hello, Mrs. Jenkins. Have a seat. Thank you. Hi. How are you? Well, not too good. I think I might have got a chest infection. Oh dear. Yeah. [coughs] Tell me more about that. Well, I’ve had a cough for quite a while now. And it just seems to be going onto my chest. I’m finding it– I’m having trouble sleeping. It’s so bad. Oh dear. Yeah. So you say for a while now. How long has it been? Oh, probably about 10 days. OK.

It just– it started off with just a normal cold and then it just sort of– the cough wasn’t too bad to begin with, but it’s just got worse. OK. OK. So you’ve been coughing about 10 days. Yeah. It seems to be getting worse. Yeah. And are you coughing up anything? Well, my nose is a bit bunged up. So yeah, I’m coughing up a little bit of phlegm. OK. Yeah. Any difficulty breathing at all? [coughs] When I– yeah, when I have a coughing bout, yes. OK. So if you’re coughing a lot, you kind of lose your breath a bit? Yeah. [coughs] What about at other times when you’re not coughing, when you’re exercising or things? No. No? No, no, not really.

OK. Any pains in your chest? No, no. No? No. Have you had a temperature at all, a high temperature? [coughs] I don’t know. I don’t think so. OK. No, no. Well, we’ll check that. I don’t think so. And I see from your records that you’re generally healthy, no sort of normal lung problems or anything like that. No, I’m normally fine. Yeah. OK. OK. [coughs] Well look, I’ll have a good look at you in a second. Before I do, can you just tell me, what is it that you’re most worried about? What are your main concerns about this? Well, no real concerns really. I just want to get rid of this cough. It’s just the cough. Yeah. OK.

So you’re kind of hoping for something [coughs] to help you get rid of it quickly. Definitely. Yeah. If there’s something you could give me to– OK. Are you worried it’s something more serious at all? Again, not really. I’m just sick of coughing, and I just want to be able to take something to get rid of it. Yeah. My husband wants me to have antibiotics. So if they’re going to help, then I’ll definitely give them a go. Yes, yeah. OK. So you’re keen to take them if they’re going to help. Yeah, definitely, ‘cause nothing’s helping, really. Yes.[coughs] OK. OK. Yeah. Fine. OK. So let’s have a look at you now, then. And after, we’ll have a chat about that. OK?

All right. Thank you. Thanks. So the patient in that clip just wanted something to make her cough go away more quickly. But sometimes asking about concerns can elicit specific concerns, such as a concern that something more serious is going on, or context-specific issues, such as wanting to get better before a wedding or a holiday. Asking about antibiotics brings the issue to the fore and starts the discussion. If a patient has very strong views about wanting antibiotics, I don’t usually argue with them. I instead try and steer the direction of a backup or delayed prescription.