SCA practice case · Video consultation
“The hospital hasn’t rung me — have my scan results come through to you?”
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
Bogdan Nowak · 68 years · male
Setting
Video — patient booked himself in to ask about his CT scan; the hospital letter has reached the GP before anyone has spoken to him.
Past history
- Hypertension
- Ex-smoker — 40 pack-years, stopped 2019
- Occupational asbestos exposure (builder, 1980s)
- Suspected lung cancer pathway referral 3 weeks ago (cough 4 months, weight loss; CXR right hilar mass)
Medication
- Amlodipine 5 mg once daily
Allergies
No known drug allergies
Recent notes
Letter from respiratory consultant received this morning: CT chest/abdomen — 4.6 cm spiculated right upper lobe mass, enlarged right hilar and subcarinal nodes (largest 1.8 cm), two indeterminate 8 mm liver lesions, no effusion, no bone lesions. “Highly suspicious of primary lung cancer.” MDT: PET-CT and EBUS biopsy requested; lung clinic in 6 days. “Patient not yet informed of CT findings.” Bloods 2 weeks ago: Hb 128, adjusted Ca 2.41, eGFR 72.
Reason for contact
Video appointment booked by patient: “results of my scan”.
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)
When a result reaches the GP first and the patient asks directly, it is usually right to tell him — withholding information he wants and has a right to is not justified by an outpatient appointment next week (GMC Decision making and consent, 2020). Use a structure such as SPIKES: set up (privacy, support, time), perception, invitation, knowledge (warning shot, plain language, honest about uncertainty), emotions (silence, naming, empathy) and strategy/summary (next steps, key worker, support, safety-net, follow-up). Avoid guessing prognosis; find what matters (here, a wedding) and pass it on. Tell the lung team he has been informed, so the clinic builds on, rather than repeats, the conversation.
The guidance behind it
Similar SCA cases
gpreasoning.uk is not affiliated with or endorsed by the RCGP. Our cases are original teaching material written for practice; none is an exam recall. For anything official about the SCA, check the RCGP SCA pages.