SCA practice case · Video consultation
“The letter that says it’s working its way in”
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
Salma Iqbal · 57 years · female
Setting
Video consultation — patient distressed by a kidney/eye letter.
Past history
- T2DM (9 yrs)
- Raised urine ACR
- Background retinopathy (screening)
Medication
- Metformin
- Gliclazide
- Ramipril
- Atorvastatin
Allergies
NKDA
Recent notes
⚠ Annual review: HbA1c 75 (58 last year). ACR raised. BP 150/92. Retinal screening: background retinopathy. Repeats (including metformin) collected as usual.
Reason for contact
Video consultation after results letter. Reception note: “very upset about her kidneys”.
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)
A complications letter lands as a death sentence when the patient hears only "kidneys" and "eyes" and fills the gap with a relative’s end-stage disease. The first task is accurate reframing: background retinopathy and microalbuminuria are EARLY and actionable, the opposite end of the spectrum from dialysis. The examinable hidden agenda is two-layered: despair ("what is the point") and a concealed cause — she stopped metformin months ago for GI side effects and is ashamed, experiencing complications as punishment. The HbA1c jump (58→75) is the clue: explore adherence with genuine non-judgement, and the confession opens. Receive it without shaming, remove blame explicitly, and convert it into a plan — MR metformin and an SGLT2 inhibitor for renal/cardiac protection (NICE NG28, updated February 2026), tightened BP to the NICE NG203 target and ACE inhibitor titration, all framed as armour. Restore agency: the letter bought time; control from here slows or halts progression.
The guidance behind it
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