Table 1 Sample clinical vignettes: conditions for which antibiotics are generally not recommended

Asymptomatic bacteriuria vignettes

Mrs. Jones is an 83 year old woman with left-sided weakness from a stroke. Your medical assistant informs you that “she has really smelly urine.” At her baseline, she is incontinent of bowel and bladder and non-ambulatory. Her functional status is unchanged, her temperature is 97.8 F, her other vital signs are normal, and she appears to otherwise be in her usual state of health except for her smelly urine.

Mrs. Jones is an 83 year old woman who thinks her urine is more smelly lately. At her baseline, she has occasional urinary incontinence, uses a wheelchair to get around after she had a stroke, and has a hard time getting to the bathroom because it. She doesn’t have a fever, and she appears to otherwise be in her usual state of health except for her smelly urine.

Upper respiratory infection vignettes

Mrs. Smith is a 91 year old woman with moderate dementia and heart failure. You notice she has a cough, runny nose, and low grade fever, but otherwise seems well. Her appetite is still good, her last recorded temperature was 97.4, her other vital signs are normal.

Mrs. Smith is a 91 year old woman with a little memory trouble and heart failure. She starts to have a cough, runny nose, and low grade fever, after a visit with her family, but otherwise seems well with no trouble breathing. She is eating and drinking fine and hasn’t had a high fever.

Wound vignettes

Mr. Jones is an 82 year old with long-standing diabetes. He had a witnessed fall while standing and scraped his forearm catching himself from his fall. He is otherwise uninjured and did not hit his head. He is able to ambulate immediately thereafter and the wound is a superficial skin tear without deep tissue injury.

Mr. Jones is an 82 year old with diabetes for a long time. He fell when getting up from breakfast this morning and scraped his forearm catching himself from his fall. He is otherwise uninjured and did not hit his head. He can walk without any trouble after the fall. The scrape is not very deep, just a scratch barely through the skin, bleeding a little bit.