SCA practice case · Telephone consultation
“I’m ready to go back to work — but do I have to tell them what’s wrong with me?”
Telephone consultation
Adult patient
Typical
Long-term conditions & cancerProfessional & 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
Ewa Nowak · 36-year-old woman
Setting
Telephone — routine appointment booked by the patient before a return-to-work meeting.
Past history
- Relapsing-remitting multiple sclerosis — diagnosed 7 months ago (MRI brain and spine, CSF)
- Relapse 4 months ago — admitted, IV methylprednisolone; physiotherapy and occupational therapy on discharge
Medication
- Dimethyl fumarate 240 mg twice daily (hospital-prescribed disease-modifying therapy; MS team monitors bloods)
- Pregabalin 75 mg twice daily
- Amantadine 100 mg twice daily
Allergies
No known drug allergies
Recent notes
Neurology clinic letter (6 weeks ago): “Good recovery from relapse. Residual mild right leg weakness and fatigue. Lymphocytes 1.1 ×10⁹/L, LFTs normal — continue DMF with 3-monthly monitoring. MS nurse contact details given. Review in 6 months.” Fit notes issued monthly since the relapse: “neurological illness — not fit for work”; last one expires in 9 days. Influenza vaccine: not recorded this season.
Reason for contact
Telephone appointment: “Want to talk about going back to work.”
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)
Return-to-work consultations test whether the doctor can turn medical facts into practical, lawful advice. MS (like cancer and HIV) is deemed a disability under the Equality Act 2010 from diagnosis, so the employer must not discriminate and must consider reasonable adjustments — disclosure is voluntary but usually helps. The fit note (“may be fit for work”) is a powerful tool: be specific about phased return, amended duties, altered hours and workplace adaptations. Occupational Health and the Access to Work scheme add support. Always ask about driving in neurological conditions: anyone with MS must tell the DVLA, which then decides; the GP explains the duty and records the advice, and GMC guidance describes when a doctor may need to inform the DVLA if a patient continues to drive when unfit. Heat-related worsening (Uhthoff phenomenon) and fatigue are common and should shape adjustments. Offer the annual flu vaccine (infection can trigger relapse) and keep the MS nurse involved.
The guidance behind it
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