SCA practice case · Telephone consultation
“You can’t write this down — promise me it stays off my record”
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
Aiden Frost · 34 years · male
Setting
Telephone — patient asked to speak to a doctor.
Past history
- Nil recorded
Medication
- Nil regular
Allergies
NKDA
Recent notes
⚠ Occupation: commercial airline pilot. Call-back request: "personal, would only speak to a GP."
Reason for contact
Telephone: "wants to discuss something personal."
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 patient demanding "promise it stays off my record" cannot be given that promise — accurate, contemporaneous records are a professional duty, and the honest answer is confidentiality WITH its limits: information stays within the care team and is not shared without consent EXCEPT where there is a serious risk to the patient or others. Here the stakes are sharpened by public safety: a commercial pilot with depression, escalating alcohol and possible suicidal thoughts may be unfit to fly, creating a duty (paralleling DVLA) to manage honestly — encourage self-reporting to his aeromedical examiner, and know that disclosure to protect the public is permissible as a last resort if he is unfit and continues to fly against advice. Explore suicidal thoughts explicitly and agree a safety plan (not a risk score — NICE NG225), treat the depression (NICE NG222) and alcohol (NICE CG115), and navigate the regulatory issue proportionately (persuade, involve him, disclose only what is necessary). The examinable hidden agenda is career-terror and shame driving the secrecy demand; the skill is to ENGAGE and RETAIN him — honest about the impossible promise without driving him away — and to reframe honesty and proper treatment as the route that protects both his career and the public, rather than secrecy that endangers both.
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.