SCA practice case · Telephone consultation
Blood and cancer: SCA practice case
A son’s call from abroad about his father
Telephone consultation
Older adult patient
Someone else speaking
Hard
Professional & ethical dilemmasOlder adultsInvestigations & results
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
Stavros Konstantinou (caller: Andreas Konstantinou, son) · 86-year-old man
Setting
Telephone consultation with the son of an elderly patient, calling from overseas about his father’s recent scan.
Past history
- Hypertension
- Moderate bilateral hearing loss (hearing aids)
- Unintentional weight loss of 7 kg over 4 months; iron deficiency anaemia (Hb 102)
Medication
- Amlodipine 5 mg once daily
- Ferrous fumarate 210 mg twice daily (started 3 weeks ago)
Allergies
No known drug allergies
Recent notes
CT chest, abdomen and pelvis four days ago: 4 cm mass in the head of the pancreas with multiple liver lesions, highly suspicious of metastatic pancreatic cancer. Suspected cancer pathway referral sent to the hepatopancreatobiliary team yesterday. Appointment booked with you tomorrow at 10am at Mr Konstantinou’s request (in person, hearing aids). Lives alone; neighbour helps with shopping. Son Andreas lives in Melbourne. No consent to share information recorded for any relative.
Reason for contact
Telephone call from his son in Australia asking for his father’s scan 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)
Collusion requests from loving relatives are common and come from fear and past experience. The GP must protect the confidentiality of a patient with capacity and must not agree to withhold information he may want, but should listen, use what the relative knows, and ask the patient how much he wants to know and who he wants involved. The skill is to say no to the request while saying yes to the son: empathy for his mother’s death and his distance, honesty that his father will be told about the call, and a practical route for him to be involved with his father’s consent.
The guidance behind it
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