ℹ️ This is the case information for the doctor.
Name
Gladys Rooney
Age
79 years old
Address
24 Oakdene Avenue, Wythenshawe, Manchester
Social history
Past history
Investigation results
Medication
Booking note
Call from paramedic.
ℹ️ This is the information for the person role playing the patient.
Name
Gladys Rooney
Age
79 years old
Address
24 Oakdene Avenue, Wythenshawe, Manchester
Social history
Past history
Medication
Hi doctor, thanks for getting back to me. I’m James, the paramedic with Gladys Rooney. We came after her husband rang 111 because she was very breathless today. She’s not keen on going in to hospital, so I wanted your advice.
Observations
Details of Presenting Problem
Ideas
The paramedic and family are unsure of the cause of the deterioration and want advice.
Concerns
Expectations
Paramedic:
How to give cues/reactions:
Key points for candidate:
ℹ️ To mark data gathering & diagnosis select from the descriptors below.
Positive descriptors
Negative descriptors
Makes effective use of existing information and considers the wider context.
Fails to use the information provided or understand the wider context.
The presence or absence of relevant red flags was established.
Fails to assess key information necessary to determine risk.
Information gathered placed the problem in its psychosocial context.
The social and psychological impact of the problem was not adequately determined.
Relevant information was collected to place the undifferentiated problem in context and an appropriate differential diagnosis generated.
Inadequate information was collected to determine the likely cause of symptoms.
Uses an understanding of probability based on prevalence, incidence, and natural history to aid decision-making.
Choice of diagnosis and/or investigations does not reflect disease likelihood.
Revises hypotheses as necessary in light of additional information.
Rigid consulting with new information not adequately considered and integrated into the working diagnosis.
ℹ️ To mark clinical management & medical complexity select from the descriptors below.
Positive descriptors
Negative descriptors
Offers management options that are safe and appropriate:
Fails to provide appropriate and/or safe management choices:
Continuity of care is prioritised:
Ongoing care is uncoordinated:
Empowers self care and independence:
Management fails to foster self care and patient involvement:
Prescribes safely considering local and national guidance:
Unsafe prescribing ignoring best practice:
Practises holistically, promoting health, and safeguarding:
Fails to safeguard patient welfare:
Manages uncertainty, including that experienced by the patient:
Manages uncertainty, including that experienced by the patient:
ℹ️ To mark relating to others select from the descriptors below.
Positive descriptors
Negative descriptors
Shows ability to communicate in a person-centred way:
Communication is doctor-centred and lacks empathy:
Shows understanding of medical-legal principles and regulatory standards:
Fails to give appropriate regard to key legal aspects of consulting:
Explores the patient’s agenda, health beliefs and preferences:
Fails to recognise the patient's agenda and impact of the problem:
Demonstrates flexibility of communication adapting to the patient and scenario:
Consults rigidly, providing generic explanations and management plans:
Works collaboratively in a team showing respect for colleagues:
Fails to work effectively with team members to deliver optimal care:
Checks the paramedics understanding of the consultation including any agreed plans:
Does not seek to confirm understanding:
ℹ️ Insights from the examiner
Examiners expect data gathering to be targeted and led by open questions, especially in cases with third-party callers like a paramedic. In this case, starting with a broad open question to the paramedic such as,
"Can you talk me through what has been happening with Gladys today and any observations you have recorded?" encourages the paramedic to provide a professional overview of the present situation. Follow-up with targeted questions for any gaps in the picture, for example: "Does she get breathless at rest, or just on exertion?" "Are there any new symptoms, like chest pain, palpitations, or fever?"
Early clarification of what the paramedic has already checked (e.g., vital signs, chest auscultation, oxygen saturations) saves time and provides valuable information. Rapid review of the social context (“Who’s with her at home? How are they coping?”) and her normal baseline supports management choices later.
References:
This is a professional to professional conversation so use of common medical terms is expected. Keep your language clear and accessible and avoid long winded sentences which lack a clear focus. Acknoweledge the dilemma.
“It sounds like she’s really struggling today, and it makes sense she might feel scared about going into hospital.” Share clinical reasoning in clear terms collaborating with your paramedic colleague , e.g.: “I agree with you that infection is one possible cause. Her swelling and breathing pattern also make me think about her heart working less well.” Be mindful of tone—collaborative, not paternalistic. “Let’s think this through together.”
Pick up on and validate emotional and situational cues from the paramedic (concern Gladys wants to stay home), from the patient/family (history of negative hospital experience), and from the clinical context (fatigue, swelling, increasing reliance on others).
Involve all parties in setting realistic goals that align with the wishes of Gladys and her family. Relating to others in this scenario doesn't just mean relating to Gladys, it means relating to the paramedic, and her family members too.
Work to maintain logical flow—start broadly with open questions to get the big picture and then zeroing on missing data necessary for risk assessment such as red flags such as targeted questions on cardiac/respiratory causes
Acknowledge information as it’s given.
A clearly prioritised list demonstrates targeted reasoning:
References:
Elicit the effect on daily function and carer ability:
“How much is this affecting her ability to get out of bed, wash, and use the toilet?” “How is her husband managing with this – is he able to help, or is it putting both of them at risk?” This ensures proportionate and safer planning.
Keep explanations tightly focused. For instance:
“Her symptoms sound most like a flare of heart failure, which means fluid is building up in her legs and lungs and making her breathless. The usual first step is a water tablet, but she’ll need close monitoring because of her blood pressure and other health problems.”
Articulate clinical reasoning out loud to the paramedic:
“I’m thinking heart failure mainly, rather than infection. She’s at higher risk because of her heart history and swelling.” Share risk assessments;
“I’m a little worried about her low BP—Furosemide could help, but we have to be cautious. Let’s keep a close watch.”
Present a range of practical, guideline-aligned options:
Check and summarise mutual understanding with:
“Are you happy with that plan for now? Do you or Gladys or her husband have any concerns?” “Would you be able to update me if her breathing changes, or if her husband struggles?”
Shape the plan to Gladys’ unique context:
“It’s a tough balance—her blood pressure is a little low, so a water tablet could lower it more, but with careful monitoring at home, it’s a reasonable option if we all work together.”
“If you’re past 6 or 7 minutes in data gathering, wrap up and start management. Open questions, open questions, open questions at the start!”
