SCA practice case · Video consultation
“My acne’s ruining my life — I want the strong tablets that cure it”
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Reece Holloway · 19 years · male
Setting
Video consultation — acne; requesting stronger treatment.
Past history
- Acne vulgaris
Medication
- Previous topical acne gel
- OTC acne washes
Allergies
None recorded
Recent notes
Student. No previous mental health consultations recorded.
Reason for contact
"My acne’s ruining my life. I want the strong tablets."
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
Acne is too often dismissed as trivial/cosmetic — the skill is to take BOTH the skin AND its psychological toll seriously. Moderate-to-severe inflammatory acne with scarring failing topicals warrants stepping up (combination topicals; oral antibiotics WITH a topical, never antibiotic monotherapy) and DERMATOLOGY referral for ISOTRETINOIN (specialist-prescribed, not GP-prescribed), treating early to limit scarring. Isotretinoin’s realities must be explained: high efficacy but monitoring (lipids/LFTs), teratogenicity/Pregnancy Prevention Programme, mucocutaneous effects, and MOOD/mental-health monitoring (MHRA) — so the mental-health assessment is part of safe isotretinoin care. The examinable hidden agenda is that the consultation is NOT just a prescription request: the psychological impact is severe (social withdrawal, missing lectures, low mood) with fleeting suicidal thoughts about appearance, which MUST be assessed explicitly — reaching the suicidal ideation behind "it’s ruining my life" is the crux — with mood support and safety-netting. Treat the skin AND the mind, validate the distress without minimising the acne, and never process the script in isolation. Isotretinoin is dermatologist-prescribed and highly effective but requires specialist supervision: TERATOGENICITY (Pregnancy Prevention Programme — critical in females; relevant to counsel), monitoring (lipids/LFTs), mucocutaneous side effects, and the MOOD/MENTAL-HEALTH consideration — a careful mental-health assessment is part of isotretinoin care (MHRA guidance on mood/suicidality monitoring). The GP’s role: optimise/step up treatment, refer appropriately, and — crucially — assess and address the mental-health impact.
The guidance behind it
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