SCA practice case · Telephone consultation
“Why does Dad’s certificate say heart failure — and why can’t we bury him yet?”
Telephone consultation
Older adult patient
Someone else speaking
Hard
Professional & ethical dilemmasOlder adultsEthnicity, culture & diversity
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
Lionel Cohen (deceased) · 81 years · male
Setting
Telephone — son of a patient who died at home three days ago calls about the death certificate and the funeral.
Past history
- COPD (GOLD 3) — home nebuliser
- Ischaemic heart disease — MI 2016
- Heart failure with reduced ejection fraction (EF 30%, 2024)
- Type 2 diabetes
- Lived with wife Ruth (78); son Daniel is next of kin and executor
Medication
- (At death) Bisoprolol, ramipril, furosemide, dapagliflozin, atorvastatin, aspirin, trimbow inhaler, salbutamol nebules
Allergies
No known drug allergies
Recent notes
Telephone consultations: 15 days before death (duty doctor) — increased breathlessness, home visit requested by wife; doxycycline and prednisolone prescribed. 10 days before death (Dr Shah) — “a bit better”; wife requested a visit; advised to continue, review in a week. Died at home 3 days ago (found in chair, 05:00; police: not suspicious). MCCD by Dr Shah: 1a congestive cardiac failure, 1b ischaemic heart disease; II COPD. Medical examiner scrutiny in progress; ME officer spoke to son yesterday. Family Jewish — urgent burial requested.
Reason for contact
Telephone call from son about the death certificate and the funeral.
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)
Since 9 September 2024 the medical examiner system is statutory in England and Wales: any doctor who attended the deceased during life can complete the MCCD (the old 28-day rule has gone), and every death not investigated by a coroner is independently scrutinised by a medical examiner, who also speaks with the bereaved and can raise concerns or notify the coroner. Families usually need three things: a plain explanation of the certificate (part I is the causal sequence; part II contributing conditions), a clear picture of the process and timing (registration within 5 days, faith needs considered), and a safe place to raise concerns about care. Respond to concerns openly — listen, say sorry for the distress, explain the routes (medical examiner, practice review, meeting, complaint) honestly including the possible effect on timing — and look after the bereaved, whose anger often carries guilt.
The guidance behind it
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