SCA practice case · Video consultation
Blood and cancer: SCA practice case
A man with lung cancer wants to talk about his treatment
Video consultation
Older adult patient
Someone else speaking
Hard
Long-term conditions & cancerOlder adultsProfessional & 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
Raymond Pryce · 68-year-old man
Setting
Video consultation requested by the patient; his wife joins him on the call.
Past history
- Adenocarcinoma of the lung, stage 4 with liver metastases (diagnosed five months ago)
- COPD (mild)
- Ex-smoker, 40 pack-years, stopped 2015
Medication
- Carboplatin, pemetrexed and pembrolizumab every three weeks (cycle 3 given ten days ago)
- Folic acid 400 micrograms daily and vitamin B12 injections (with pemetrexed)
- Dexamethasone around chemotherapy
- Ondansetron as needed
- Tiotropium inhaler once daily
- Salbutamol inhaler as needed
Allergies
No known drug allergies
Recent notes
Oncology letter last month: treatment intent palliative, to control disease and prolong life; scan after cycle 4. Weight 71 kg (was 80 kg at diagnosis). No advance care plan, ReSPECT form or lasting power of attorney recorded. Wife Pauline is next of kin.
Reason for contact
Video consultation booked by the patient: “to talk about the chemo”.
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 competent adult may decline treatment, including life-prolonging chemotherapy, even when a loved one disagrees. The GP’s task is to check understanding, screen for depression without pathologising the decision, give both partners space, and turn “stopping” into a positive plan: oncology informed, advance care planning, palliative care, symptom control and carer support. The hidden agenda is his brother’s death in intensive care; the safety-net must remember that his last cycle was only ten days ago.
The guidance behind it
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