SCA practice case · Video consultation
“I’m fine, my mum’s just overreacting”
Video consultation
Young person patient
Hard
Children & young peopleMental health & addictionProfessional & ethical dilemmas
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
Maya · 15 years · female
Setting
Video consultation — teenager seen alone after mother’s concern.
Past history
- Nil significant
- No previous mental health contact
Medication
- No regular medication
Allergies
NKDA
Recent notes
⚠ Appointment booked by mother: withdrawn, not eating with the family, grades dropping. Mother waiting outside.
Reason for contact
“I’m fine, my mum’s just overreacting.”
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 guarded "tell my mum I’m fine" teenager seen alone is a confidentiality-and-risk consultation. The hinge is establishing confidentiality and its limits explicitly and early, in age-appropriate language — only then will disclosure follow. Conduct an explicit, sensitive risk assessment (ask directly about self-harm method/frequency and about suicidal thoughts, plan, intent, means, and protective factors — asking does not plant ideas), assess Gillick competence (decision-specific; Fraser guidelines apply to contraception advice, not to confidentiality in mental health), avoid risk tools, scales and low/medium/high labels (NICE NG225), and screen the psychosocial picture (HEEADSSS) to surface the real triggers — here online bullying and questioning her sexuality, with terror of being outed. Respond to self-harm by exploring its function (emotion regulation) without shame or alarm, not by simply demanding it stop. Make a proportionate plan (NICE NG225: referral for psychosocial assessment with consent, safety-planning; CAMHS/early help, school/bullying support, crisis routes, follow-up; NICE NG134: psychological therapy first-line for low mood), and judge parental involvement by risk and competence — negotiating any disclosure WITH her wherever safe. The marks are won by ethics held under genuine warmth.
The guidance behind it
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