Lesson 5.2 — Full SCA RTO Walkthroughs

Lesson 5.2 — Full SCA RTO Walkthroughs

These are communication walkthroughs, not complete clinical mark schemes. The medical content of a real case must follow current guidance. The purpose here is to show how RTO can run through the consultation rather than appearing as one isolated empathy line.

Walkthrough 1 — Antibiotics requested for a respiratory illness

1. Open broadly and let the patient describe the illness.
2. Notice the expectation cue: the upcoming event and belief that antibiotics will speed recovery.
3. Explore: “It sounds like being well for the event is really important. What were you hoping antibiotics would do for you?”
4. Assess the illness safely.
5. Explain your reasoning in plain language and directly address the expectation.
6. If antibiotics are not indicated, do not simply refuse; offer symptom control, expected course and a contingency plan.
7. Check: “How does that plan sit with you, given the event you’re trying to get to?”
8. Safety-net specifically.

Walkthrough 2 — Patient wants an MRI for back pain

1. Explore the story and red flags.
2. Pick up the meaning behind the request: reassurance, validation, previous experience or fear of cancer.
3. Say what you think and why imaging may or may not help.
4. Acknowledge that pain can be severe even when imaging is not the next useful step.
5. Offer a positive management plan rather than “no scan”.
6. Agree review points and what would change the need for imaging.

Walkthrough 3 — Antidepressant reluctance

1. Do not immediately correct the belief.
2. Explore what “change my personality” means and where the concern came from.
3. Assess risk and severity appropriately.
4. Explain options in chunks, including non-drug approaches where appropriate.
5. Connect the plan to the patient’s priorities.
6. Respect a reasonable refusal and arrange review/safety-netting.

Walkthrough 4 — Menopause symptoms and HRT anxiety

1. Acknowledge the family experience before discussing treatment.
2. Clarify the relative’s history and the patient’s own risk context as clinically appropriate.
3. Ask which symptom is affecting life most and what outcome matters most.
4. Explain benefits, risks and alternatives using current guidance.
5. Check understanding and invite questions.
6. Agree a plan that reflects both symptoms and risk tolerance.

Walkthrough 5 — Parent worried about a child

1. Recognise that the current anxiety is shaped by a previous experience.
2. Explore briefly what happened last time.
3. Assess the child safely.
4. Explain what is reassuring today and what you are specifically watching for.
5. Give concrete safety-netting and access instructions.
6. Check the parent feels able to use the plan.

Walkthrough 6 — Chronic pain and feeling dismissed

1. Do not defend previous clinicians.
2. Validate the reality and impact of symptoms without claiming an unsupported diagnosis.
3. Explore what the patient thinks “normal tests” mean.
4. Clarify goals: diagnosis, function, sleep, work, symptom control.
5. Explain your formulation and next steps collaboratively.
6. Avoid framing psychological support as proof the symptoms are imaginary.

Walkthrough 7 — Obesity discussion without judgement

1. Ask permission to discuss weight where appropriate.
2. Use neutral language and connect the discussion to the patient’s stated goals.
3. Explore previous attempts and barriers without moral judgement.
4. Offer evidence-based options and support.
5. Agree a realistic next step rather than delivering a lifestyle lecture.

Walkthrough 8 — Safeguarding cue in a relationship

1. Treat the cue as important and consider immediate safety.
2. Explore sensitively and privately; do not confront or make assumptions.
3. Clarify safe methods of contact.
4. Follow safeguarding principles and local pathways.
5. Explain confidentiality and any limits relevant to safety.
6. Document and arrange safe follow-up in real practice.

Walkthrough 9 — Patient refuses urgent referral

1. Explore the practical barrier before repeating the recommendation.
2. Explain your level of concern clearly and proportionately.
3. Problem-solve support options rather than framing the patient as non-compliant.
4. Check understanding of risk.
5. If the patient still refuses, respect autonomy where they have capacity while documenting and safety-netting appropriately.

Walkthrough 10 — Embarrassed sexual-health consultation

1. Normalise the clinical discussion without normalising away the emotion.
2. Explain why personal questions are relevant.
3. Use neutral, inclusive language.
4. Ask permission and allow the patient to pause.
5. Summarise confidentiality and testing/treatment options clearly.
6. End without judgement.

Walkthrough 11 — Work pressure and a fit note request

1. Explore symptoms, function and workplace context.
2. Understand what the patient hopes time off will achieve.
3. Assess clinical and safety issues.
4. Discuss options including adjustments or staged plans where appropriate.
5. Avoid either automatically granting or reflexively resisting the request.
6. Agree follow-up and review of function.

Walkthrough 12 — Multiple problems in one consultation

1. Acknowledge all agendas early when possible.
2. Prioritise transparently: safety first, then what can realistically be addressed today.
3. Use a mini-summary to show you have heard the patient.
4. Negotiate what will be covered now and what needs follow-up.
5. Do not make the patient feel punished for bringing more than one issue.
6. Close with a clear plan for the deferred problem.