Lesson 6.3 — Case Lab: Scenarios 13–18
Case Lab 13 — Childhood obesity conversation
A parent attends with a child whose weight is clinically relevant.
Parent: “Please don’t talk about weight in front of her. She’s already self-conscious.”
“But we need to discuss her BMI.”
The candidate has not negotiated a sensitive way to discuss a clinically relevant issue.
“Thank you for telling me. I don’t want this conversation to make her feel judged. Let’s agree how we can talk about health and growth in a way that feels safe for her.”
Use age-appropriate, non-stigmatising language and involve the child appropriately while respecting safeguarding and clinical needs.
How would you proceed if the child asks directly, “Am I fat?”
Case Lab 14 — Migraine and work pressure
A patient with migraine is considering preventive medication.
“I can’t take anything that makes me sleepy — I operate machinery.”
Listing medication options without changing the discussion.
A key occupational factor has not influenced the plan.
“Because you operate machinery, drowsiness is particularly important. Let’s compare the options with that in mind.”
Use occupation to personalise risks, timing and choice, and document safety advice in real practice.
What if the most effective option has a small sedation risk?
Case Lab 15 — Positive STI test
A patient receives a positive STI result.
“My partner will think I cheated.”
“You need to tell your partner.”
The candidate moves straight to action without exploring safety, relationship context or fear.
“It sounds as though you’re worried about what this result could mean for your relationship. Before we talk about partner notification, are you worried about how your partner might react?”
Explain treatment and partner notification while considering safety and available sexual-health support.
What if the patient fears violence?
Case Lab 16 — Patient requests a sick note
A patient with work stress asks for a long fit note.
“I just need three months away from that place.”
“I can only give you two weeks.”
The consultation becomes a negotiation over duration before understanding function and goals.
“Work sounds like a major part of what’s going on. What is happening there, and what are you hoping time away would allow you to do?”
Assess health and function, discuss appropriate certification and possible adjustments, and agree review.
How would you respond if the patient says their manager is bullying them?
Case Lab 17 — New cancer referral
A patient needs an urgent suspected-cancer referral.
“So you think I’ve got cancer?”
“No, it’s just a routine pathway.”
This risks false reassurance and minimises the significance of the referral.
“I don’t know that you have cancer. Most people referred on this pathway will not turn out to have it, but your symptoms need checking promptly so we don’t miss something important.”
Explain what happens next, expected timing, how results are communicated and what to do if symptoms change.
How would you respond to silence or tears after saying 'cancer'?
Case Lab 18 — Opioid reduction
A patient on long-term opioids is asked to review treatment.
“You’re going to take away the only thing that helps.”
“These drugs are addictive and we need to reduce them.”
The response may feel threatening and overlooks the patient’s fear of uncontrolled pain.
“It sounds as though the idea of changing them feels like losing your main way of coping with the pain. Tell me what you’re most worried will happen if we reduce them.”
Explain risks, goals and tapering collaboratively, and discuss alternative pain strategies and follow-up.
What if the patient interprets tapering as disbelief in their pain?