SCA practice case · Telephone consultation
“I want the form, doctor”
Telephone consultation
Older adult patient
Typical
Older adultsProfessional & ethical dilemmasHealth disadvantage & vulnerabilities
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
Stanley Kerr · 79 years · male
Setting
Telephone — patient calling on his own behalf.
Past history
- Severe COPD (FEV1 28%), home nebulisers
- Moderate heart failure
Medication
- COPD inhalers and nebulisers
- Heart failure medication
Allergies
NKDA
Recent notes
⚠ Two COPD admissions last winter. No ReSPECT or DNACPR on file. Widowed, lives alone. Son Michael visits Sundays.
Reason for contact
Booked by patient: “Resuscitation paperwork — wants the doctor, not the nurse.”
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 capacitous patient’s request for DNACPR is theirs to make: capacity is confirmed through the conversation, mood screened (values-based refusal ≠ depression), the scope corrected (CPR only — everything else continues; the "they’ll stop trying" fear delays these requests for years), and the law stated plainly — family are informed with consent, never asked permission, and cannot overturn it. The DNACPR form itself is not legally binding; if he wants a refusal that binds clinicians after he loses capacity, the instrument is an advance decision to refuse treatment (MCA 2005 ss24–26). Honest CPR-outcome data for severe COPD/HF is information, not persuasion. The hidden agenda is double: the brother’s ICU death driving the timing, and the secret-from-the-son plan — the real consultation is converting the drawer into a three-way conversation, with the GP volunteering to take the heat.
The guidance behind it
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