SCA practice case · Telephone consultation
“I’ve got power of attorney for Mum — so can I say no to the hospital test?”
Telephone consultation
Older adult patient
Someone else speaking
Hard
Older adultsProfessional & ethical dilemmasInvestigations & results
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
Bridget O’Connor · 83 years · female
Setting
Telephone — daughter who holds a health and welfare lasting power of attorney calls about her mother’s blood results.
Past history
- Alzheimer’s disease — moderate to severe (diagnosed 2020)
- Hypertension
- Osteoarthritis
- Lives at home; carers twice daily; daughter visits daily
- Health and welfare LPA registered 2021 — daughter Siobhan sole attorney (copy scanned to record; includes life-sustaining treatment)
Medication
- Donepezil 10 mg at night
- Amlodipine 5 mg once daily
- Paracetamol 1 g up to four times daily when required
Allergies
No known drug allergies
Recent notes
Community nurse 3 weeks ago: “pale, more tired”. Bloods and FIT 8 days ago: Hb 92 g/L (115–165), MCV 74 fL, ferritin 6 µg/L, platelets 412, CRP 4, eGFR 58, tTG negative. FIT 85 µg Hb/g (threshold 10). GP letter sent to the attorney recommending a suspected cancer pathway referral (lower GI) and inviting a discussion.
Reason for contact
Telephone call from daughter (health and welfare attorney) about the results letter.
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 health and welfare LPA gives the attorney authority only when the donor lacks capacity for the specific decision, and only to decide in the donor’s best interests (MCA 2005 s4): her past and present wishes, beliefs and values, the views of people close to her, and the least restrictive option. The attorney can consent to or refuse treatment offered (refusing life-sustaining treatment only if the LPA expressly allows it) but cannot insist on treatment. A positive FIT with iron deficiency in advanced dementia is a genuine best-interests decision: present realistic options, assess capacity for this decision, consult family and carers, treat the anaemia, support the carer, document — and if agreement cannot be reached, the Court of Protection decides.
The guidance behind it
Similar SCA cases
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