SCA practice case · Telephone consultation
“The wrong dose went out — and they’ve been taking it”
Telephone consultation
Older adult patient
Hard
Professional & ethical dilemmasUrgent & unscheduled careOlder adults
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
Maureen Selby · 67 years · female
Setting
Telephone — proactively disclosing a prescribing error.
Past history
- Condition treated with methotrexate (once-weekly regimen intended)
Medication
- Methotrexate — ⚠ last issue labelled DAILY in error
Allergies
None recorded
Recent notes
⚠ Prescribing error flagged today: daily instead of weekly directions. Estimated 6 days of daily doses taken. No blood results since the issue.
Reason for contact
Telephone call initiated by you to disclose the error and arrange urgent action.
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 methotrexate dose issued DAILY instead of WEEKLY — taken for ~6 days — is a classic, potentially fatal prescribing error, and the consultation has two inseparable strands. Clinically: act URGENTLY despite the patient feeling well — stop the drug, urgent bloods (FBC, U&E, LFTs), assess for toxicity (mucositis, GI upset, marrow suppression/infection/bleeding, pneumonitis), and seek specialist/toxicology advice (folinic acid rescue, possible admission), with clear toxicity red-flag safety-netting. Ethically: fulfil the DUTY OF CANDOUR (CQC Regulation 20; GMC/NMC 2015) — disclose promptly, honestly and fully, APOLOGISE sincerely (an apology is not an admission of legal liability), explain what happened and what will be done, follow the call with an offer to meet in person and a written account including the apology, keep a record, and commit to a system response (significant event analysis, fixing the prescribing/dispensing safeguard, checking other patients). The examinable skills are doing this WITHOUT defensiveness or minimising, and managing the patient’s fear and self-blame — explicitly lifting the "I took it like it said" self-blame (it was the system’s error, not hers) — while keeping her informed, supported and treated as a partner in putting it right.
The guidance behind it
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