SCA practice case · Video consultation
Older adults: SCA practice case
A daughter’s request about her mother’s tablets
Video consultation
Older adult patient
Someone else speaking
Typical
Older adultsProfessional & ethical dilemmasLong-term conditions & cancer
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
Margaret Doyle · 88-year-old woman
Setting
Video consultation with the patient’s daughter, who is calling from her mother’s room in the nursing home.
Past history
- Alzheimer’s disease, advanced (diagnosed 7 years ago); in a nursing home for 3 years
- Atrial fibrillation
- Hypertension
- Osteoporosis (wrist fracture 2019)
- Hypothyroidism
- Osteoarthritis of knees and hips
- Low mood with agitation (2023)
Medication
- Donepezil 10 mg at night
- Apixaban 2.5 mg twice daily
- Amlodipine 5 mg once daily
- Ramipril 5 mg once daily
- Atorvastatin 40 mg at night
- Alendronic acid 70 mg once weekly
- Calcium and colecalciferol chewable tablet twice daily
- Sertraline 50 mg once daily
- Lansoprazole 15 mg once daily (no indication recorded)
- Levothyroxine 75 micrograms once daily
- Paracetamol 1 g four times daily
Allergies
No known drug allergies
Recent notes
Nursing home review notes this month: weight 44 kg (51 kg six months ago), hoisted, bed and chair bound, pureed diet and thickened fluids after speech and language therapy assessment, says single words, needs full help with eating. Seated BP 102/58, pulse 76 irregular. Bloods 4 weeks ago: eGFR 48, Hb 118, TSH 2.1, potassium 4.6. Nursing note: ’refuses tablets, crushed into yoghurt by staff’; no covert administration plan on file. No lasting power of attorney. No ReSPECT form. Next of kin: daughter Siobhan (only child).
Reason for contact
Video consultation requested by her daughter: ’wants to talk about stopping Mum’s tablets’.
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 relative asking to stop all medicines is usually asking for something else as well: to be heard, to protect a parent’s dignity and to make amends. The GP needs to be clear and kind about the law (the daughter is consulted, she does not consent), then do a genuine best-interests review medicine by medicine. Most preventive drugs can stop; comfort drugs stay; anticoagulation, sertraline and donepezil need a plan rather than a reflex. Crushed tablets in food without a covert administration process is a safeguarding and governance issue to deal with today.
The guidance behind it
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