Evidence-Based Management Plans for the SCA
Your management plan must be evidence-based, patient-centred, and practical. The examiner is assessing whether you would be safe as an independent, newly qualified GP.
- Start by sharing your working diagnosis with the patient
- Offer options, not instructions: “There are a couple of approaches we could take...”
- Explain the rationale for each option
- Check the patient’s preference: “What do you think would work best for you?”
- Agree on a shared plan together
Option Sharing & The Gift-Wrapping Technique:
Clinical Management is the domain where most SCA candidates lose marks. The three main reasons are: running out of time, lack of clinical knowledge, and poor option sharing — knowing what to do but not being able to present it effectively.
The 4-Options Rule
For every common GP condition, know at least four management options. SCA cases are deliberately designed to eliminate the obvious ones. If you only know two and both are blocked, you are stuck.
| ⚠ COMMON PITFALL: Simply listing all options without guidance is not shared decision-making — it is dumping. The patient came for expert advice, not a menu. This is where gift wrapping comes in. |
The Gift-Wrapping Technique
Gift wrapping means presenting all options but making the most appropriate one sound the most appealing. You are not being deceptive — you are using clinical expertise to guide the patient toward the best evidence-based choice while respecting their autonomy.
| ✅ GIFT-WRAPPED OPTIONS | Doctor: We have a few options. You’ve tried painkillers and the forearm strap. What I’d recommend now is specialist physiotherapy with strengthening exercises — the evidence is good. We could also consider a steroid injection, but it can actually slow recovery long-term. My suggestion: physio first, injection as backup. How does that sound? |
| ❌ OPTION DUMPING | Doctor: Well, you could try painkillers, physio, a strap, a steroid injection, or referral. What do you want to do? |
When There Is Only One Option
Some cases have only one appropriate management (meningitis = ambulance, 2WW cancer referral). Do not fabricate alternatives. Explain clearly why and explore the patient’s concerns.
Prescribing Without the BNF:
Since the BNF is no longer available, you must know for the 30–40 most commonly prescribed drugs: drug name (generic), standard starting dose, common side effects, key contraindications, monitoring requirements, and duration of treatment.
You do not need every dose to the milligram. Demonstrating a safe prescribing approach (right drug, reasonable dose, appropriate warnings, plan to review) is more important than exact dose recall.