SCA practice case · Video consultation
“I survived the ICU — so why am I a wreck? Everyone says I should just be grateful”
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
Martin Oduya · 52 years · male
Setting
Video consultation — months after a critical-illness ICU admission.
Past history
- ICU admission five months ago — severe pneumonia/ARDS, ventilated three weeks
- No critical-care follow-up on record
Medication
- Reconcile medication since discharge
Allergies
None recorded
Recent notes
⚠ Discharge summary five months ago after three weeks of ventilation. No 2 to 3 month rehabilitation review recorded.
Reason for contact
Video consultation: “I survived — so why am I a wreck?”
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)
POST-INTENSIVE-CARE SYNDROME (PICS) is the recognised cluster of new or worsening impairments persisting after critical illness/ICU across three domains: PHYSICAL (ICU-acquired weakness, fatigue, breathlessness, reduced exercise tolerance, weight loss, post-intubation voice/swallow problems), COGNITIVE (impaired memory, attention and processing — "brain fog"), and PSYCHIATRIC (depression, anxiety and POST-TRAUMATIC STRESS DISORDER with flashbacks, nightmares and hyperarousal). The first therapeutic act is to RECOGNISE and NAME it — legitimising the survivor’s experience — because PICS is frequently missed when patients are discharged without structured follow-up (NICE CG83 expects a functional reassessment 2 to 3 months after critical care discharge — missed here), and survivors often feel guilt and are told they "should just be grateful". Screen all three domains systematically: physical function and breathlessness while acting on physical red flags (worsening breathlessness, chest pain, haemoptysis, weight loss, fevers); depression/anxiety with validated tools and PTSD symptoms, plus suicidality risk; and cognition and capacity to work. Institute a coordinated MULTI-DOMAIN rehabilitation plan — physiotherapy and graded reconditioning, with pulmonary rehabilitation only where a local programme accepts post-critical-illness patients; treatment of mood/anxiety (NG222) and trauma-focused psychological therapy (trauma-focused CBT, or EMDR, per NICE NG116) for PTSD; cognitive strategies and graded return-to-work/occupational support; sleep; and social/family support — referring to an ICU-recovery clinic where available. Address the guilt and the "be grateful" narrative directly and compassionately: gratitude for survival and genuine suffering coexist, PICS is common and treatable, and struggling is neither weakness nor ingratitude; involve and educate the family. Close the follow-up gap proactively and track the referrals. Physical red flags are screened and safety-netted.
The guidance behind it
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