SCA practice case · Telephone consultation
Older adults: SCA practice case
A paramedic calling about a fall at home
Telephone consultation
Older adult patient
Someone else speaking
Typical
Older adultsUrgent & unscheduled careProfessional & 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
Ivy Thornton · 91-year-old woman
Setting
Telephone consultation with a paramedic who is with the patient at her home after a fall.
Past history
- Hypertension
- Osteoporosis (vertebral fracture 2022)
- Osteoarthritis of knees
- Ankle oedema
- Fall 8 months ago (no injury)
- Lives alone; carers once daily (morning)
Medication
- Amlodipine 5 mg once daily
- Furosemide 20 mg each morning
- Alendronic acid 70 mg once weekly
- Colecalciferol 800 units daily
- Paracetamol 1 g up to four times daily when required
Allergies
No known drug allergies
Recent notes
Last GP review 3 months ago: walks indoors with a frame, independent with personal care apart from bathing, no cognitive concerns recorded. Bloods then: eGFR 52, sodium 137, potassium 4.3. Personal alarm pendant supplied after last fall. No ReSPECT form. Next of kin: daughter Pauline (lives 2 hours away).
Reason for contact
Telephone call from paramedic Gareth Price, at Mrs Thornton’s home at 08:55, asking for GP advice.
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)
The paramedic wants permission either to override a 91-year-old or to leave her. The law gives neither shortcut: capacity is presumed, assessed for this decision, and an unwise choice is still hers to make. With dark urine after a ten-hour lie she needs blood tests today, and with a symptomatic postural drop on two antihypertensive-type medicines there is a fixable cause. The skill is to solve the reason she is saying no and build enough of a hospital-level plan at home that both the patient and the paramedic are safe.
The guidance behind it
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