SCA practice case · Video consultation
Older adults: SCA practice case
A request for fewer tablets
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
Gordon Fairbairn · 72-year-old man
Setting
Video consultation for a structured medication review requested by the patient.
Past history
- Type 2 diabetes (15 years)
- Chronic kidney disease stage 3b, ACR 12 mg/mmol
- Heart failure with reduced ejection fraction (LVEF 35% on echo 2023) after myocardial infarction 2019
- Gout: last flare 8 months ago (left big toe)
- Osteoarthritis of knees
Medication
- Metformin 1 g twice daily
- Gliclazide 80 mg twice daily
- Dapagliflozin 10 mg once daily
- Ramipril 5 mg once daily
- Bisoprolol 5 mg once daily
- Spironolactone 25 mg once daily
- Furosemide 40 mg each morning
- Atorvastatin 80 mg at night
- Aspirin 75 mg once daily
- Allopurinol 200 mg once daily
- Colchicine 500 micrograms twice daily (on repeat since gout flare 8 months ago)
- Omeprazole 20 mg once daily (started 2017 with naproxen; naproxen stopped 2020)
- Amlodipine 5 mg once daily (started 2016, before the heart failure diagnosis)
- Calcium carbonate with colecalciferol, one tablet twice daily (no indication recorded)
Allergies
No known drug allergies
Recent notes
Bloods last week: eGFR 38 (42 a year ago), potassium 5.3, sodium 137, HbA1c 49 mmol/mol, urate 310 micromol/L, adjusted calcium 2.48. Nurse review: sitting BP 112/64, weight 84 kg (stable), reported feeling dizzy on standing. Home glucose meter readings brought by patient: 3.6 and 3.8 mmol/L at about 4am on two nights last month. Drives. Main carer for his wife, who has early Alzheimer’s disease.
Reason for contact
Booked a video medication review himself: “Want fewer 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)
Polypharmacy reviews in multimorbidity are not about counting tablets but about matching each medicine to the patient’s goals. This patient’s request for fewer tablets hides real harms: nocturnal hypoglycaemia on gliclazide, postural dizziness from an unnecessary antihypertensive, metformin above the dose for his eGFR, indefinite colchicine, and furosemide skipped because of toilet access. The skill is to stop what harms or has no indication, keep the prognostic heart failure and kidney medicines with a clear explanation, stagger the changes, and notice the carer behind the request.
The guidance behind it
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