SCA practice case · Telephone consultation
“It’s just IBS, I get it when I’m stressed”
Telephone consultation
Adult patient
Typical
Long-term conditions & cancerNew & 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
Diane Foster · 59 years · female
Setting
Telephone — change in bowel habit she’s self-labelled as IBS.
Past history
- Nil significant
- No previous bowel symptoms on record
Medication
- No regular medication
Allergies
NKDA
Recent notes
⚠ No FIT, FBC or coeliac serology on file. BMI 26. Teacher. No known family history of bowel cancer.
Reason for contact
Telephone consultation. “Can I have something for my IBS?”
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 NEW change in bowel habit at 59 with rectal bleeding and weight loss is a colorectal red-flag cluster, not IBS — and IBS is a diagnosis of exclusion that should never be newly applied at this age without investigation. The NICE NG12/FIT pathway applies: offer quantitative FIT (NICE HTG690) and refer on a colorectal suspected cancer pathway if FIT ≥10 µg Hb/g (a low FIT does not end it while concern persists; the Faster Diagnosis Standard aims for an answer within 28 days), with baseline bloods (FBC/ferritin) and examination, and without simply prescribing an antispasmodic. Distinguish genuine IBS (NICE CG61: at least 6 months of symptoms; chronic/lifelong, pain related to defaecation, bloating, NO bleeding/weight loss/nocturnal symptoms/anaemia) from this picture. The examinable hidden agenda is self-soothing denial — a colleague her age recently diagnosed with bowel cancer drove her to the least frightening label — plus a practical dread of taking time off mid-term. Surface the fear gently, decline the convenient label without catastrophising or dismissing her, address the practical barrier, and complete FIT and the suspected cancer pathway referral with follow-up. The skill is refusing the anchored self-diagnosis while keeping her on side.
The guidance behind it
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