Lesson 6.1 — Case Lab: Scenarios 1–6
Case Lab 1 — Chest pain with a hidden fear
A 44-year-old presents with intermittent chest discomfort. Initial history sounds low risk.
“My brother had a heart attack at 45. I haven’t told my wife I’m here.”
“Okay. Does the pain radiate anywhere?”
The candidate has heard a clinically and emotionally important cue but has not responded to it. The consultation risks becoming a symptom checklist.
“You mentioned your brother’s heart attack and that you haven’t told your wife. It sounds as though this has been worrying you more than you first let on. Tell me what’s been going through your mind.”
Use the family history and fear when explaining your risk assessment and next steps. Do not offer false reassurance before completing the clinical assessment.
How would you respond if the patient says, “I’m scared I won’t see my children grow up”?
Case Lab 2 — Contraception and confidentiality
A 19-year-old asks about contraception and seems hesitant.
“My mum knows everyone at this surgery. She can’t find out.”
“Don’t worry, it’s confidential.”
The reassurance is directionally helpful but too quick. The patient may need a clear explanation of confidentiality and its limits before feeling safe enough to speak.
“I can see why privacy matters here. What you tell me is confidential, and I won’t routinely share it with your family. There are limited situations where we may need to act if someone is at serious risk, and I’d explain that to you. Does that help?”
Then ask what method or outcome matters to the patient, and make the plan without assumptions about relationships or sexual activity.
How would your approach change if the patient disclosed coercion?
Case Lab 3 — New diabetes and shame
A patient has newly diagnosed type 2 diabetes.
“I knew this would happen. I’ve done this to myself.”
“You just need to lose weight and improve your diet.”
This reinforces blame and misses the patient’s emotional response. It may reduce engagement with treatment.
“You sound as though you’re blaming yourself quite heavily. Diabetes is influenced by several factors. Would it be okay if we talk about what this diagnosis means and what changes feel realistic for you?”
Offer evidence-based management while identifying practical barriers, priorities and support. Keep language neutral.
What would you say if the patient becomes tearful and says they have tried to lose weight for years?
Case Lab 4 — Asthma and inhaler embarrassment
A teenager has poor asthma control.
“I don’t use the inhaler at school. People stare.”
“You need to use it regularly or your asthma won’t improve.”
Clinically true information is delivered before understanding the barrier. Adherence is unlikely to improve.
“Using it at school sounds uncomfortable because you feel people notice. What usually happens when you need it there?”
Use the answer to agree a realistic plan: technique, timing, school support, privacy or regimen as clinically appropriate.
How could you check the plan without sounding like you are testing the patient?
Case Lab 5 — Menopause and fear of HRT
A 51-year-old has troublesome menopausal symptoms and is considering HRT.
“My aunt had breast cancer. I don’t want to take something that could give me cancer.”
“The absolute risk is small.”
The candidate jumps to risk statistics before establishing what the family experience means to the patient.
“I can understand why your aunt’s experience makes the word HRT feel worrying. Would you tell me a little about what happened and what risk you’re most concerned about?”
Then discuss individual benefits, risks and alternatives using current guidance, checking how the information lands.
How would you respond if the patient says, “Just tell me what you would do”?
Case Lab 6 — Persistent cough and smoking
A smoker presents with a persistent cough.
“I know you’re going to tell me off about smoking.”
“Well, smoking is the main risk factor.”
The response confirms the patient’s expectation of judgement and may close down the consultation.
“I’m not here to tell you off. Smoking is relevant to the cough, but I’d like to understand what’s been happening and what you want help with today.”
Assess safely, then ask permission to discuss smoking and offer support without making cessation a moral test.
How do you discuss cancer risk without sounding punitive?