SCA practice case · Video consultation
“The result nobody actioned”
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
Geoffrey Lam · 61 years · male
Setting
Video consultation — booked by the practice: duty doctor to explain a missed result.
Past history
- Nil significant
- FH: father — bowel cancer, died at 66
Medication
- No regular medication
Allergies
NKDA
Recent notes
⚠ 11 Jan: Hb 108, ferritin 9 — filed “normal, no action”. 2 Apr: Hb 96, ferritin 6. Suspected cancer pathway colonoscopy and OGD referral sent; FIT requested; significant event logged.
Reason for contact
Practice-booked video call: duty GP to explain the missed result.
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)
Duty of candour done properly: state the error plainly ("abnormal, filed as normal"), apologise with the word sorry and no qualifiers (apology is not legal admission), give a precise factual account, the concrete system fix, and the SEA outcome in writing — while respecting the complaint as the patient’s right, neither deflected nor pushed. The clinical layer: unexplained IDA in a 61-year-old man needs urgent GI investigation — FIT (NICE NG12, updated April 2026: FIT ≥10 → suspected cancer pathway) and bidirectional endoscopy (BSG 2021), TTG, iron once daily started, the referral expedited with the delay documented. The 91-days question gets the two-part honest answer: tumour biology rarely turns on 3 months, AND the camera is the only real answer — plus the under-asked truth that IDA is often benign. The hidden agenda — a father dead of late bowel cancer at 66, a lifetime of dread, the arithmetic, the wife who doesn’t know — is what converts a complaint meeting into a consultation.
The guidance behind it
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