SCA practice case · Telephone consultation
Mental health: SCA practice case
A widower who is not eating
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
Kenneth (Ken) Mallory · 83-year-old man
Setting
Telephone consultation with an older man, arranged after his daughter rang the practice with concerns.
Past history
- Hypertension
- Benign prostatic hyperplasia
- Retired farmer
- Wife Joan died at home 6 weeks ago (pancreatic cancer); he was her main carer
Medication
- Amlodipine 5 mg once daily
- Tamsulosin 400 micrograms once daily
Allergies
No known drug allergies
Recent notes
Weight 78 kg at hypertension review 3 months ago. Last bloods 3 months ago: FBC, U&E, LFT normal; HbA1c 41. Joan’s record: syringe driver and oral morphine in the last week of life; community palliative team discharged after her death. Daughter Susan rang yesterday: ’Dad not eating, lost weight, drinking whisky at night, please ring him.’ No previous mental health history.
Reason for contact
Telephone consultation with Mr Mallory, arranged after his daughter’s call. He knows she rang.
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)
Older men who are recently bereaved, drinking and living alone carry one of the highest suicide risks in general practice, and they rarely volunteer it. ’Not eating’ is the ticket; hopelessness, rehearsal with his wife’s morphine and a shotgun at home are the reality. The skill is to ask directly, uncover the guilt that he caused her death, address means the same day, and secure urgent specialist help without the ’fuss’ he dreads, while not forgetting that 6 kg of weight loss at 83 also needs a physical review.
The guidance behind it
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