"Hello, I’m [Your Name], one of the doctors/nurses. I understand you've come in today to discuss some respiratory symptoms you've been experiencing. Is that right?"
"Before we go any further, what are your thoughts about what might be causing your breathing problems, or what it might mean?"
"And is there anything in particular that you're worried about, or anything you were hoping we could achieve during our conversation today?"
"Could you please tell me more about your main symptom? What is it, and how would you describe it? When did it start, and did it come on suddenly or gradually? What makes it better or worse?"
"Let's go through some key respiratory symptoms. Are you experiencing any shortness of breath (dyspnoea)? If so, when does it occur – on exertion, at rest, or both? How severe is it – for example, how many flights of stairs can you climb or how far can you walk before you get breathless? Do you get breathless when lying flat (orthopnoea), or wake up breathless at night (paroxysmal nocturnal dyspnoea)?"
"Do you have a cough? When did it start, and how long have you had it? Is it dry or do you bring up phlegm (productive)? What color and consistency is the phlegm? Do you ever cough up blood (haemoptysis) – is it just streaks, or frank blood? What about a barking or bovine cough?"
"Do you ever experience wheezing or a whistling sound when you breathe? When does it occur – on breathing in or out?"
"Have you had any chest pain? If so, where is it, how would you describe it (e.g., sharp, dull, heavy, tight), does it spread anywhere? Does it get worse when you breathe in (pleuritic pain)? What about sweating, fever, or unexplained weight loss?"
"I also need to ask about some important 'red flag' symptoms. Have you been coughing up blood? Do you have a persistent cough that's lasted more than three weeks? Have you had any unexplained weight loss or persistent hoarseness? Have you had recurrent chest infections or pneumonia? Have you noticed any new clubbing of your fingertips? Have you had any sudden swelling and pain in one leg, which could indicate a blood clot, especially if you're also short of breath? Or any sudden, severe shortness of breath?"
"Do you have any existing medical conditions, such as asthma, COPD (emphysema or chronic bronchitis), bronchiectasis, cystic fibrosis, interstitial lung disease, previous pneumonia, or a history of tuberculosis (TB)? What about a collapsed lung (pneumothorax), a blood clot in your lungs (pulmonary embolism), or heart failure? Do you have any known allergies?"
"Have you ever had any lung surgeries or procedures, like removal of part of your lung (lobectomy), or a bronchoscopy?"
"Do you have any other medical diagnoses, such as autoimmune conditions or HIV, or diabetes? What about any other previous surgical history?"
"Regarding vaccinations, have you been vaccinated against respiratory diseases such as influenza (the flu jab), pneumococcus (pneumonia jab), COVID-19, or tuberculosis (like the BCG jab)?"
"Are you currently taking any medications, including anything prescribed by a doctor, or any over-the-counter medicines, supplements, or herbal remedies? This includes any inhalers you might be using – what type are they, how often do you use them, and are you finding them effective? Are you taking any oral steroids or immunosuppressants? Some medications, like certain blood pressure tablets (ACE inhibitors) can cause a cough, and others like amiodarone or methotrexate can affect the lungs."
"Do you have any allergies to medications or anything else? If so, what kind of reaction did you have?"
"Does anyone in your close family – like your parents, siblings, or children – have a history of respiratory disease, such as asthma, COPD, cystic fibrosis, or alpha-1 antitrypsin deficiency? What about tuberculosis? Is there any family history of heart disease, autoimmune conditions, or cancer?"
"Could you tell me a little about your living situation and who you live with? Do you have a good support network around you? How do your symptoms affect your daily activities?"
"How about your lifestyle? Do you smoke, and if so, how much and for how long? Have you been exposed to passive smoke? How much alcohol do you drink in a week? Do you use any recreational drugs?"
"Have you been exposed to any allergens, such as animal dander, pollen, dust, or mould?"
"What kind of work do you do now, and what about jobs you've had in the past? Have you had any exposure to pulmonary irritants or other hazardous substances, such as asbestos, coal dust, silica, or various chemicals?"
"If your symptoms suggest an infection, have you travelled recently, especially to areas where certain diseases like tuberculosis or specific fungal infections are common? Have you been exposed to anyone with a similar illness?"
"Do you have any hobbies that might expose you to respiratory risks, such as bird keeping, caving, or farming?"
"Thank you very much for sharing all of that information with me. Just to summarise, you've been experiencing [recap key symptoms], which started [onset] and are often [character/timing]. This has been impacting your [daily life areas]. You've also mentioned [recap relevant PMH/DH/FH/SH]."
"Does that sound like an accurate summary? Is there anything else you feel is important that we haven't covered?"
"Based on what you've told me, the next steps would be for me to perform a physical examination, focusing on your respiratory and cardiovascular systems, and checking your vital signs. We would also likely arrange for some investigations, such as a chest X-ray, an ECG (heart tracing), blood tests (like a full blood count, kidney function tests, CRP to check for inflammation, and potentially an arterial blood gas to assess oxygen levels). We might also do lung function tests, and depending on the findings, a CT scan of your chest or even a bronchoscopy with bronchoalveolar lavage might be considered."
"Do you have any questions for me at this stage?"
"Thank you for your time."