SCA practice case · Telephone consultation
“My old doctor always gave me a few diazepam”
Telephone consultation
Adult patient
Typical
Mental health & addictionProfessional & ethical dilemmas
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
Donna Preadon · 46 years · female
Setting
Telephone — request for diazepam from a newly-registered patient.
Past history
- Anxiety (patient-reported)
Medication
- Diazepam (patient-reported; dose not confirmed)
Allergies
NKDA
Recent notes
⚠ New registration. Previous records not received. No prescriptions issued by this practice.
Reason for contact
Telephone: “I just need you to put my diazepam through. My old doctor always gave me a few.”
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 "just continue my diazepam" request from a long-term user with tolerance, withdrawal symptoms and online top-ups is benzodiazepine DEPENDENCE, and the examinable skill is the dependence fork: neither prescribe on demand nor refuse flatly. A flat refusal precipitates dangerous withdrawal (seizures) and drives her to the riskier online/illicit supply; unquestioning continuation entrenches an escalating, harmful dependence — especially with concurrent alcohol (benzodiazepine + alcohol/opioids risks respiratory depression). The safe path acknowledges dependence without judgement or labelling, ensures safety (no abrupt stop; address alcohol; safe bridging), and offers a structured gradual taper (NICE NG215; step size per BNF) plus proper treatment of the underlying anxiety (NICE CG113: CBT or guided self-help and an SSRI, sertraline first) rather than ongoing benzodiazepines. Verify the dose (Summary Care Record or previous practice) before issuing small dated supplies; the MHRA (Drug Safety Update, March 2020) warns of potentially fatal respiratory depression with benzodiazepines and opioids. The hidden agenda is shame and fear of being cut off, with the drug (and alcohol) medicating an unaddressed driver — here her child’s serious-illness diagnosis. Surface and treat the cause, build an alliance so she stays engaged rather than going elsewhere, obtain the old records, and safety-net withdrawal red flags with continuity of care.
The guidance behind it
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