SCA practice case · Telephone consultation
“I’m only ringing for my blood results — I’m not going into hospital, so don’t ask”
Telephone consultation
Adult patient
Hard
Investigations & resultsUrgent & unscheduled careMental health & addiction
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
Jordan Fletcher · 32-year-old man
Setting
Telephone — results call booked after a nurse practitioner arranged bloods two days ago.
Past history
- Bleeding gastric ulcer 18 months ago — OGD: gastric ulcer, CLO test positive for H. pylori; transfused 2 units
- Alcohol-use disorder (recorded)
Medication
- No current medicines (omeprazole and eradication therapy prescribed 18 months ago — not reordered; eradication not confirmed)
Allergies
No known drug allergies
Recent notes
Advanced nurse practitioner (2 days ago): “Tired all the time, breathless on stairs, palpitations for 2 weeks. HR 112 regular, BP 98/60, RR 18, SpO2 97%, T 36.4 °C. Looks pale. Chest clear, HS normal. Bloods sent; review with results.” Results (2 days ago): Hb 74 g/L (130–180), MCV 71 fL (80–100), MCH 22 pg (27–33), WCC 8.1, platelets 410 ×10⁹/L (150–400); urea 11.8 mmol/L (2.5–7.8), creatinine 78 µmol/L (60–110); bilirubin 17, ALT 58 U/L (<50), GGT 214 U/L (<60), albumin 37 g/L; ferritin pending.
Reason for contact
Telephone appointment: “Blood test results.”
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 refusal is the start of the conversation, not the end. Explore the reason (here: a child at home, fear of losing contact, previous stigma), give honest information about risk including death, then assess capacity for the specific decision (understand, retain, use or weigh, communicate — Mental Capacity Act 2005). An unwise decision does not mean incapacity, and recent alcohol does not automatically remove capacity. If he has capacity, respect the refusal (GMC decision-making and consent guidance) and reduce risk: speak to the on-call medical or gastroenterology team today (many units offer next-day ambulatory endoscopy for patients who decline admission), agree PPI with them, stop NSAIDs, prescribe thiamine for a dependent drinker, advise against abrupt alcohol cessation, avoid starting oral iron before endoscopy (it blackens stools and confuses monitoring), give clear 999 advice, and document thoroughly. When a dependent child is at home with a parent at risk of collapse, secure another adult now. H. pylori status should be rechecked (at endoscopy, or by stool antigen or breath test at least two weeks off PPI).
The guidance behind it
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