SCA practice case · Telephone consultation
Women’s health and pregnancy: SCA practice case
An advance decision before planned surgery
Telephone consultation
Adult patient
Hard
Gender, reproductive & sexual healthEthnicity, culture & diversityProfessional & ethical dilemmas
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
Lorraine Fairweather · 52-year-old woman
Setting
Telephone consultation requested by the patient to discuss an advance decision before planned gynaecological surgery.
Past history
- Uterine fibroids (uterus 18-week size on ultrasound); heavy menstrual bleeding for 2 years
- Iron deficiency anaemia
- Jehovah’s Witness (recorded: ’declines blood transfusion’)
Medication
- Ferrous sulfate 200 mg once daily (started 8 weeks ago)
- Tranexamic acid 1 g three times daily on heavy days
Allergies
No known drug allergies
Recent notes
FBC last week: Hb 71 g/L (84 g/L three months ago), MCV 68, platelets 410; ferritin 4 micrograms/L. Gynaecology letter: listed for total abdominal hysterectomy, expected in about 10 weeks; pre-operative assessment in 3 weeks; ’patient is a Jehovah’s Witness and declines blood; haematology and anaesthetic planning required’. No advance decision on file.
Reason for contact
Telephone appointment requested: ’to discuss my advance decision about blood before my operation’.
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)
A request to witness a form is really three tasks. First, her anaemia is severe and worsening, she has stopped her iron, and transfusion is not an option: that makes intravenous iron and stopping the bleeding urgent. Second, the advance decision must meet the Mental Capacity Act requirements for refusing life-sustaining treatment, and her choices about fractions and cell salvage need to be explicit. Third, there is fear and a family rift beneath a firm faith. Respect the belief, check it is freely held, and make the plan safe within it.
The guidance behind it
Similar SCA cases
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