67-year-old lady for left hemithyroidectomy
- Moderate COPD. Can walk 100m on flat. Ceased smoking 10 years ago.
- OSA –Compliant with CPAP
- BMI 41
- Bipolar Affective Disorder – severe anxiety. Lives alone. Brother is enduring guardian
- Multinodular Goitre for many years. Euthyroid.
- Surgical letter states worsening dyspnoea. Uncertain if due to goitre. Some tracheal deviation but no retrosternal extension
- Chronic dyspnoea. Documented over many years by respiratory physician
- Extensive investigations: Spiro and DLCO around 50% of predicted
Cardiac investigations including stress echo NAD
- Difficult to gain accurate history over phone. Patient not answering phone.
- Distance patient. No transport options
- Brother lives far away but calls her every night
- Discussed with brother – doesn’t feel she is any worse. SOB for many years
- Independent with ADLs. Shops and cooks for herself.
- GP declined to share medical information
- Referred back to respiratory physician; “better than she was 10 years ago.’ unsure why she needs a thyroidectomy.
- Discussion with surgeon who liaised with respiratory physician and GP. Decision to cancel as procedure not required.
Phone consultation in Distance patients
- Clinical assessment can be very challenging in these circumstances.
- Surgeon seems to have had the same difficulties with telehealth
- How can we best assess distance patients? Face to face appointments would be the best way to assess but not always possible.
- Can we videocall vs ask GP for clinical assessment – again would require significant set-up
- Asking a local physician who knew the patient well turned out to be an ideal solution in this situation.