Scenario 1 - Tonsillitis

Hello? Is that Mr Smith?

Hello?

Hello? Is that Mr Smith?

Yeah.

Mr Smith, my name is Sean I am one of the urgent care practitioners from the doctors out of hours service. I am ringing back about your call today.

Oh hello.

Hello there, Mr Smith. Before we go any further can you just confirm your full name and date of birth, so I have got the right notes in front of me, please?

My name is Mark Smith.

Yeah.

Date of birth, 15th of May, 1960.

So I have got your details in front of me, Mr Smith. So I understand you have rung the service today and I can see from the notes here they are on, you have got a problem with your throat, is that right?

Yeah, I have got a really sore throat. It hurts when I swallow.

Well, how long has it been like this for... Sorry?

What day is it today?

It is Wednesday today.

Three days, three days, my dose, yeah.

Three days. Okay, that is fine. So you have had this for three days now. Any other symptoms at all with this?

I do not feel very well.

In what way? Sorry.

I just feel my joints ache.

Aching joints. Okay. Any pain at all, anywhere?

Just in, me throat. It hurts to swallow, I can't... I can drink a little bit, but I cannot eat anything.

Any drooling at all? Where you are not able to swallow or speak?

No.

Okay, that is fine. You have been taking anything for the pain?

Just Paracetamol.

And has that been helping at all?

Little bit takes the edge off it, but it hurts when I swallow.

Okay, no worries. Any nausea or vomiting at all?

No.

If you press under your jawline where your jaw goes toward your neck, have you got any underneath there at all?

Yeah.

So you have got some pain under there.

Yes, really, it is swollen.

Alright. Okay. On the one side or both?

Both sides.

Okay then, so you might have some enlarged glands there in your neck as well. Are you able to look into a mirror for me?

Now?

Yeah, what I need you to do is go and look in the mirror, open your mouth wide, look in the mirror and see if you can see any white spots on your tonsils.

Hang on.

Thank you.

Oh yeah.

Okay.

Yeah, there is like two like bubble things and they have got white spots on them.

Okay, have you got the cough at all?

No.

No cough?

No.

Okay. What medical problems do you suffer from, Mr Smith?

What do you mean?

Any other medical history that I need to be aware of?

No.

Do you suffer from anything?

No.

Nothing at all? Do you take any medications at all? For anything?

Just Paracetamol.

Okay. And that is just what you buy over the counter?

Yeah.

Okay, super. Any allergies at all to anything?

I have got hay fever.

Oh okay, you do not take any medications for your allergies at the moment?

No.

Okay, who do you live with at your home address?

I live on my own.

And are you normally mobile able to get around?

Oh yeah.

Do you have any support at all at home?

What? What do you mean?

Anybody come in to help you with day-to-day tasks?

No, no, no.

Okay. Any family at all? Local?

No, no, I was an only child, I was.

Okay. Alright, okay, so from what we are discussing at the moment, Mr. Smith and you have told me that you have looked in the mirror, and you have got these white spots on your tonsils and the absence of a cough and the pain when you are swallowing and that sort of swelling in your throat under your jawline, I would suggest that possibly you have got acute tonsillitis. Have you ever had tonsillitis before?

I had that when I was a kid, a couple of times.

Right, okay. Based on the observations that we are discussing at the moment, I think it would be appropriate to treat you with a course of antibiotics. You say you have got no allergies at all?

No, no, there is none.

Okay. Nothing at all?

Only hay fever.

Just hay fever. But no medications that you cannot take?

No.

Okay, so I am going to give you a course of an antibiotic, which is a penicillin-based antibiotic.

I have had that before.

Oh, super. And I am going to give you this for 10 days. Okay?

Okay.

I am going to support sort this prescription out now. Which pharmacy do you normally use?

It is Boots in the square. Okay.

Okay. And so I will get this prescription sent across to there. It will be ready within the next hour for collection. What I would say to you, it is very important that you take the full course for the 10 days as directed on the prescription, you need to take this medication up to an hour prior to food or two hours after food, if you do not, then the absorption rate can be interrupted and it will not work as effectively as we would like it to. I would also say carry on taking regular paracetamol. Okay? Two Paracetamol every four to six hours. No more than eight within a 24-hour period. Carry on drinking plenty of fluids, because if you are feeling unwell, lethargic, possibly got a temperature, you may become slightly dehydrated.

So make sure you are drinking plenty. And what would say else, things that you need to be mindful of that would suggest your condition is worsening is, if you get a severe throat pain or the inability to swallow, if you start drooling or you cannot breathe correctly, it will suggest that the swelling is increasing and you need to be seen quite urgently. If that happens, Mr Smith, you need to ring 999 straight away, do you understand?

Okay.

For an ambulance, is that?

For an ambulance, yeah. We need to get you seen in a hospital straight away, because your airway may be threatened. We are gonna treat you with the antibiotics, it might take a couple of days before these to take effect. So do not worry if you do not get any immediate relief, give it at least two to three days, if you are not getting any relief after two to three days, then contact your doctor for a follow-up review. Okay?

Okay.

Just be mindful that antibiotics, sometimes the penicillin ones can cause a little bit of loose stool and vomiting, that is a normal side effect, but make sure you are taking the regular paracetamol, take the penicillin antibiotics as directed for the full 10-day course even if you start feeling better and drink plenty. If you have got any concerns at all, you speak to your own doctor for a follow-up review or you can ring back to 111 and we will have another discussion. Is that okay for you? Do you understand that, Mr Smith?

Okay, so I have got to take all these tablets?

All the 10-day course.

And I am better in three days.

Even if you are feeling better in three days, you need to still take the full course, do not stop when you start feeling better.

Oh, alright.

Alright then, and if there is any problems when you start taking the medications, any new rash, any new shortness of breath, then you need to stop taking them and ring and get some medical advice. It might be that we need to look at an alternative antibiotic for you, do you understand that as well?

Okay, yeah, that sounds good. Thank you.

That is great. Okay, and I am going to close this call now if there are any other problems you can ring us back. Thanks for your call. Mr Smith.

Thank you now. Bye-bye.