SCA practice case · Telephone consultation
“It’s just my gout again”
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
Derek Hollis · 63 years · male
Setting
Telephone — patient wants colchicine for a "gout flare".
Past history
- T2DM (11 yrs) — HbA1c 74
- Gout
- Peripheral neuropathy — high-risk foot
- Carer flag: sole carer for wife (MS)
Medication
- Metformin
- Gliclazide
- Allopurinol
- Atorvastatin
Allergies
NKDA
Recent notes
⚠ Foot check last year: reduced monofilament sensation both feet. Previous gout flare treated with colchicine.
Reason for contact
Telephone: “Needs colchicine for gout flare, can’t come in.”
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 red, hot, swollen foot in a person with diabetes and neuropathy is a limb-threatening emergency until proven otherwise — diabetic foot infection, possible osteomyelitis, sepsis — NOT a phone-script gout flare, even with a gout history. Neuropathy makes reduced pain falsely reassuring; systemic upset (rigors, deranged glucose) raises the stakes. The unsafe path is issuing colchicine remotely; the safe path follows NICE NG19: a foot with possible ulceration plus fever or signs of deep infection or sepsis is a limb- or life-threatening problem needing immediate referral to acute services, with the multidisciplinary foot care service informed (other active problems within 1 working day). But the examinable hidden agenda is WHY he’s pushing for remote care: he is a sole carer who cannot leave his wife, with a buried amputation fear borrowed from a relative. Solve the caring logistics as a clinical task (emergency cover, adult social care, a Care Act 2014 carer’s assessment), meet the fear honestly (early assessment saves feet), and safety-net for sepsis. The consultation is won by hearing the obstacle, not the request.
The guidance behind it
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