SCA practice case · Telephone consultation
Mental health: SCA practice case
A call about medication after release from prison
Telephone consultation
Adult patient
Hard
Health disadvantage & vulnerabilitiesMental health & addictionUrgent & unscheduled care
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
Darren Whitlock · 41-year-old man
Setting
Telephone consultation with a man released from prison yesterday and registered at the practice this morning.
Past history
- Neuropathic pain, left forearm (ulnar nerve injury 2019)
- Depression
- Previous heroin dependence — abstinent in custody, not on opioid substitution treatment
- Hepatitis C — treated 2023, cured
Medication
- Pregabalin 150 mg twice daily (per prison discharge summary)
- Mirtazapine 30 mg at night (per prison discharge summary)
Allergies
No known drug allergies
Recent notes
Registered this morning; address is a supported hostel. Prison healthcare discharge summary received electronically today: released yesterday after 14 months; pregabalin 150 mg twice daily and mirtazapine 30 mg at night; seven days of both supplied at release. No seizure history recorded. Last recorded weight 78 kg.
Reason for contact
Urgent telephone call requested: “I’ve got no tablets.”
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 first days after release are the highest-risk days of a prison leaver’s year: lost opioid tolerance, a hostel where drugs are offered, interrupted medicines and no money. The exam skill is to prescribe safely without becoming a gatekeeper who disbelieves: verify against the discharge summary, restart the verified dose rather than the requested one, shorten the supply and make it harder to lose, and treat the lost bag as a risk to manage rather than a lie to expose. The hidden agenda is fear of relapse and of losing contact with his daughter; a doctor who finds it can offer the drug service and naloxone as help rather than as surveillance.
The guidance behind it
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