SCA practice case · Telephone consultation
“Eleventh appointment, still angry”
Telephone consultation
Adult patient
Typical
Mental health & addictionNew & undifferentiated presentations
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
Stephen Cobb · 44 years · male
Setting
Telephone — patient demanding referral; 11th contact this year.
Past history
- Recurrent chest tightness and palpitations (14 months) — no cardiac diagnosis
Medication
- No regular medication
Allergies
NKDA
Recent notes
11 contacts this year (4 GPs, 2 ED, 1 ambulance). ECG ×3, 24-hour tape, troponin, TFT, FBC — all normal. Last note: “reassured, discharged, declined talking therapy angrily.”
Reason for contact
⚠ Telephone, self-listed “urgent”: wants cardiology referral or will go private and complain.
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)
The angry frequent attender with normal results needs three things in strict order: the legitimate grievance conceded specifically (the sigh, the six minutes — relationship injury is the true presenting complaint), the exclusion stated with numbers and honest re-entry criteria (what WOULD reopen cardiac assessment), and a POSITIVE diagnosis with mechanism — panic’s hyperventilation physiology explains every symptom in order, which "all your tests are normal" never does. Referral is neither granted to end the call nor refused as a power move: it’s parked transparently behind a dated, same-doctor plan. The hidden agenda — a coffin carried at 44, a body standing guard ever since — is offered as physiology for HIM to connect, never as "just grief". Continuity is the actual prescription.
The guidance behind it
Similar SCA cases
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