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Table 2 Examples of case vignettes

From: Family physicians’ diagnostic gut feelings are measurable: construct validation of a questionnaire

Case vignette 8 (sense of reassurance)
hi) Patient is 34 years old and works as a sales assistant in a bakery. She is married with two children. Her medical history is uneventful. She does not smoke and drinks little alcohol. The only medication she is on is Microgynon 30 (oral contraception). No significant matters in the family history.
sy) Patient visits her family physician because of a burning sensation she’s had for the last two days when urinating. She also feels pain and itch in her labias. She reports some discharge from the vulva. She was given amoxicillin for a lower airways infection two weeks ago. She has had the same complaints after a previous course of antibiotics, but cannot remember the name of the drug she was given then.
si) Patient does not appear ill and has a normal complexion. External gynecological examination shows no abnormalities. There is vaginal discharge which resembles curdled milk. No further abnormalities are visible. Urine test strips for leukocytes, blood and nitrite are negative.
Case vignette 16 (sense of alarm)
hi) A 49-year-old woman phones the ‘triagist’ at an out-of-hours medical service at 21:40 h to report pain in her left side which has been increasing over the past 4 days. The pain is linked to her breathing and feels like sore muscles. The pain appears to be episodic to some extent; there are times when it is clearly less severe. The patient does not feel an urge to move. She currently has no pain elsewhere, and has had none during the past few days. Apart from a caesarian section ten years ago, she has no medical history. The only medication the patient is on is oral contraception. She has no known allergies. The triagist decides to invite her to visit the out-of-hours medical service post the same night.
sy) As the physician collects her from the waiting room, the pain makes her walk with a stoop and she seems to experience shooting pains with each breath. She occasionally cries out for pain.
si) Blood pressure is 128/84 mm Hg, pulse rate 90 a minute, regular and even. Saturation rate is 97%. Auscultation of the heart reveals no abnormalities and the lungs present vesicular breath sounds. A striking feature is the marked local tenderness of the musculature on the left side of the thorax. Calves are supple. A chest X-ray made within the past week shows no abnormalities. The family physician decides to administer an intramuscular injection of diclofenac 75 mg combined with 2 mg diazepam, which seems to be reasonably effective.
  1. Explanation of abbreviations: hi= history, sy= symptoms, si= signs.