SCA practice case · Video consultation
“I’m just tired, doctor — and the flat’s a bit cold these days”
Video consultation
Older adult patient
Hard
Older adultsHealth disadvantage & vulnerabilitiesProfessional & 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
Rajinder (Raj) Bhatti · 79 years · male
Setting
Video — follow-up booked by the practice nurse after weight loss was noted; the patient is on his own today.
Past history
- Minor ischaemic stroke February 2025 — mild left-hand weakness, largely recovered
- Hypertension
- Hypercholesterolaemia
- Widowed 2022; lives in his own flat
- No memory concerns recorded
Medication
- Clopidogrel 75 mg once daily
- Amlodipine 5 mg once daily
- Atorvastatin 80 mg at night
Allergies
No known drug allergies
Recent notes
Practice nurse annual review 3 weeks ago: weight 61 kg (66 kg six months ago), BP 162/94. Repeat prescriptions collected irregularly (gaps of 2–3 weeks). Attended with nephew (Sunny Gill) who “answered most questions”. Nurse note: “Patient quiet. Coat on throughout.”
Reason for contact
Video follow-up with GP about weight loss and tiredness.
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)
Financial abuse of older people often presents as a health problem — weight loss, cold, missed medicines, missed appointments — with a relative who answers for the patient. See the person alone (on video, check the room), ask open questions about who manages money and shopping, and ask directly about safety. Under the Care Act 2014 an adult with care and support needs who is experiencing, or at risk of, abuse or neglect and cannot protect himself because of those needs should be considered for a safeguarding enquiry. A person with capacity has the right to make decisions about his own life; seek consent for a referral, explain what will happen, and know the exceptions (risk to others, serious crime, coercion or undue influence, vital interests). Treat the health effects too, and follow up soon.
The guidance behind it
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