LESSON 2.3: Building Your SCA Consultation Framework

First 6 Minutes: Data Gathering & Diagnosis

1. Open: Read candidate instructions carefully during 3-minute reading time. Note patient’s name, age, any results or letters provided.
2. Connect: Greet patient by name. Open question: “How can I help you today?”
3. Explore: Let the patient talk. Open questions first, then targeted closed questions. Listen for cues.
4. ICE: Elicit ideas, concerns, and expectations naturally — not as a bolt-on checklist.
5. Psychosocial: Ask about impact on daily life, work, relationships, mood. This is not optional.
6. Red flags: Screen for serious disease relevant to the presentation.
7. Summarise and signpost: “So what I’m hearing is... Let me now share my thoughts with you.”

Last 6 Minutes: Clinical Management & Complexity

1. Working diagnosis: Share your thinking. Name the likely diagnosis and explain your reasoning.
2. Management plan: Offer evidence-based options. Tailor to the patient’s preferences. Involve them.
3. Prescribing: If appropriate, name the drug, dose, duration. Mention key side effects and monitoring.
4. Referrals and investigations: Only if appropriate. Don’t over-investigate.
5. Health promotion: Brief, relevant advice where appropriate.
6. Safety netting: Specific, not generic. What to look out for, when to return, what to do if worse.
7. Follow-up: Book a review if appropriate. Offer written information.
8. Check understanding: “Does that make sense? Is there anything else you wanted to discuss?”