SCA practice case · Telephone consultation
“The handkerchief”
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 Pike · 70 years · male
Setting
Telephone — patient with known metastatic lung cancer, coughing blood.
Past history
- Metastatic NSCLC — best supportive care
- DNACPR in place
- Community palliative team involved
Medication
- Palliative symptom-control medicines (see team letters)
Allergies
NKDA
Recent notes
⚠ No record of just-in-case medicines being issued. Lives with wife, Edith. Palliative oncology: no further anti-cancer treatment.
Reason for contact
Telephone: “coughed up a bit of blood, just a teaspoon”. Three episodes in 24 hours.
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)
Small-volume haemoptysis in known advanced lung cancer is not a suspected cancer pathway referral or a reflex 999 — it is a palliative crisis-planning consultation. Assess proportionately by phone (volume, trajectory, breathing vs baseline, haemodynamics), make a decision aligned with the agreed ceiling of care and DNACPR, screen for reversible contributors (infection, anticoagulation, low platelets; oral tranexamic acid or palliative radiotherapy discussed with the team), and then do the real work: activate the community palliative team and anticipatory medicines TODAY, and build a concrete crisis plan — one number to call (not 999), crisis sedation in the house (NICE NG31 anticipatory medicines), dark towels to reduce the visual horror, positioning on his side, someone staying with him, comfort-first. The hidden agenda is the manner of death: the drowning fear and, above it, the terror of Edith witnessing it alone. Decline the patient’s minimising, name the unspeakable question, answer it honestly (a big bleed is possible, not certain, usually fast, never unsupported), and protect the person he is most frightened for. Honesty without abandonment is the whole of it.
The guidance behind it
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