Lesson 6.2 — Case Lab: Scenarios 7–12
Case Lab 7 — Medication side effects and mistrust
A patient stopped antihypertensive medication after dizziness.
“Last time nobody listened when I said the tablets made me feel awful.”
“You shouldn’t stop blood pressure tablets without speaking to us.”
The candidate prioritises correction over repairing trust and understanding the adverse experience.
“It sounds like you felt your side effects weren’t taken seriously. Tell me what happened when you were taking them.”
Acknowledge the experience, assess the symptom, explain options and agree monitoring or an alternative as appropriate.
What if the patient now refuses all medication?
Case Lab 8 — Fertility concern
A 33-year-old asks about irregular periods.
“We’ve been trying for a baby for nearly a year. I haven’t told anyone because I feel like I’m failing.”
“How often are your periods?”
The clinical question matters, but the candidate has stepped over a significant emotional and agenda cue.
“You’ve been carrying this privately for a long time, and it sounds as though you’re blaming yourself. What has this year been like for you both?”
Return to fertility goals when explaining investigations, timelines and options. Avoid implying fault.
How would you include the partner without making assumptions about the relationship?
Case Lab 9 — Benzodiazepine request
A patient asks for a repeat benzodiazepine prescription during a stressful period.
“It’s the only thing that gets me through work.”
“We don’t prescribe these long term.”
The boundary may be appropriate, but the response ignores function, dependence risk and the patient’s perceived need.
“It sounds as though work feels unmanageable without it. Before we decide what to do with the prescription, can we look at what happens on the days you feel you need it?”
Explain risks and boundaries clearly, offer safer alternatives and negotiate a plan rather than simply refusing.
What if the patient becomes angry and says you are abandoning them?
Case Lab 10 — Memory concern in an older adult
An older patient presents with forgetfulness; an adult child is present.
The child answers every question. The patient becomes quieter.
Continuing to speak mainly to the relative because it is faster.
The candidate risks undermining autonomy and missing the patient’s own perspective.
“I’m glad you’re both here. I’d like to hear from you both, but I’ll start with you, Mrs Khan — what changes have you noticed yourself?”
Clarify consent for the relative’s involvement, assess capacity where relevant, and balance collateral history with the patient’s voice.
How would you handle disagreement between patient and relative?
Case Lab 11 — Domestic abuse cue
A patient presents with anxiety and sleep problems.
“My partner gets angry if I’m late home. He checks where I’ve been.”
“Are you being abused?”
The direct question may sometimes be necessary, but here it is abrupt and may not create enough safety for disclosure.
“That sounds controlling and I’m concerned about how safe you feel at home. Are you able to talk freely with me right now?”
Prioritise immediate safety, confidentiality, safe contact and appropriate safeguarding pathways.
What if the partner is waiting outside the consultation room?
Case Lab 12 — Chronic fatigue and feeling dismissed
A patient has persistent fatigue with previous normal tests.
“I know the blood tests are normal. Everyone thinks I’m making it up.”
“The tests are reassuring, so that’s good.”
The candidate hears 'normal' but misses the patient’s experience of invalidation.
“The normal tests are useful, but they don’t mean your symptoms aren’t real. It sounds as though you’ve felt dismissed. What impact is the fatigue having on your life?”
Explain your working formulation and next steps without implying that psychological factors mean imaginary symptoms.
How would you introduce mood or stress sensitively?