“It only happens when I play”

Exertional syncope is a cardinal cardiac red flag — syncope DURING exercise, especially with preceding palpitations, is potentially life-threatening and must never be accepted as "heat and dehydration". Add a family history of young sudden cardiac death (a cousin at 23) and a young relative with a pacemaker, and the concern is an inherited cardiac condition (HCM, long QT, Brugada, ARVC, CPVT) that classically kills fit young athletes. The plan is urgent: ECG today, specialist cardiovascular assessment within 24 hours (NICE CG109 and QS71 — exertional TLoC and a family history of sudden cardiac death under 40 are each a 24-hour criterion; echo, exercise/rhythm testing, family screening), and — critically — STOP competitive/high-intensity sport and driving until assessed. The examinable hidden agenda is the minimising itself: football is his entire identity and an academy trial looms, so he actively downplays dangerous symptoms to be "signed off". The skill is to hold the professional line (no false clearance), refuse to collude, name the danger plainly but compassionately, reach the buried fear of the cousin, and take his career seriously by framing assessment as the route back to sport and to staying alive.