SCA practice case · Telephone consultation
“I just need the disulfiram, not a load of questions”
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
Gordon Slater · 51 years · male
Setting
Telephone — patient requesting help to stop drinking.
Past history
- Hypertension
Medication
- Amlodipine
Allergies
NKDA
Recent notes
⚠ Occupation: bus driver (Group 2 licence). Hypertension on amlodipine. No alcohol history coded.
Reason for contact
Telephone. “A tablet to help me stop drinking — disulfiram or whatever.”
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 bus driver asking quietly for disulfiram "to sort himself out" raises two intertwined duties. Clinically: he has physical alcohol dependence (relief/morning drinking, shakes), so a stand-alone disulfiram prescription is unsafe and inappropriate — for him it is contraindicated (BNF/SPC: hypertension, treated with amlodipine), and in anyone it requires established abstinence and supervision; and abrupt unsupported cessation risks withdrawal seizures/DTs; the right path is specialist assessment for medically-assisted withdrawal (NICE CG100: benzodiazepine regimen + thiamine) and structured relapse prevention (NICE CG115: acamprosate or oral naltrexone with psychological support). The examinable core is the PUBLIC-SAFETY/DVLA duty: a vocational (Group 2) driver, drinking around shifts and still driving, with alcohol dependence — which must be notified to the DVLA and precludes driving until criteria are met. Advise him to STOP driving and notify the DVLA; and know the confidentiality position — if he continues to drive against advice and won’t notify, the GMC permits disclosure to the DVLA to protect the public, after attempting persuasion and informing him. The hidden agenda is terror of losing his job, driving the "keep it quiet" shortcut; engage his real motivation, hold the safety line compassionately, support the occupational consequences, and safety-net the withdrawal danger.
The guidance behind it
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