Father Phoning About His Daughter's Rash, Unable to Bring Her in or Send A Photo — Free SCA Practice Case
Father phoning about his daughter's rash, unable to bring her in or send a photo
Station Timer
Golden Minute
Initial Introduction
•Introduce yourself
•Ask an open question — "How can I help you today?"
•Listen — don't interrupt
•Catch early cues
Data Gathering
History, ICE & Diagnosis
Clinical Management
Diagnosis, Plan & Decisions
Safety Net
Follow-up & Close
Materials for Candidate
Please review before starting the consultation
Full Name
Isla Pryce
Age
4 years
Consultation Type
TelephoneAge
4
Situation
Telephone Consultation. The child's father is calling.
Reason for Encounter
"My little girl's come out in a rash. I can't get her to the surgery and I haven't got a way to send you a photo — can you tell me what to do?"
Medical Records (Isla Pryce)
- ●PMH: Nil significant. Immunisations up to date.
- ●Medications: None.
- ●Allergies: NKDA.
- ●Recent notes: Nil.
Patient Script
For the friend playing the patient role
Character Overview: You are Mark, father of Isla, who is 4. She has come out in a rash today. She had a runny nose and a mild temperature over the last couple of days but is otherwise her usual self — playing, eating and drinking, chatting. You cannot bring her to the surgery (you have no car and are minding her and her baby brother alone) and you cannot send a photo (you have an old phone with no camera/data). You are worried and want to know what the rash is and what to do. You will do whatever the doctor advises, including finding a way to get her seen if told it is important. If guided, you can do a "glass test" on the rash.
Opening Sentence: "Hello Doctor. My daughter Isla, she's four, has come out in a rash today. I'm a bit worried. The trouble is I can't get her to the surgery — no car, and I've got the baby too — and I can't send a photo, my phone's ancient. Can you help me over the phone?"
History if Asked (Data Gathering Phase)
- ●The rash: "It's a blotchy pinkish-red rash, mostly on her tummy and chest, came on today. It's not raised much. I hadn't noticed it spreading fast."
- ●Recent illness: "She's had a runny nose and a mild temperature the last couple of days — I've been giving her Calpol."
- ●How she is in herself: "She's her normal self, really — playing, eating and drinking, chatting away. Not floppy or drowsy."
- ●The logistics: "I honestly can't get her in — no car, and I'm on my own with her and the baby. And my phone can't take photos."
- ●What he wants: "I just want to know what it is and what I should do."
ICE — Ideas, Concerns, Expectations
The caller does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.
- ●Ideas: Mark thinks it is probably a viral rash from her cold but is not sure. "I'm guessing it's a viral thing from her cold, but I don't really know."
- ●Concerns: His underlying fear is meningitis — he has heard about rashes and meningitis. "What's really in my head is meningitis — you hear about the rash, don't you?"
- ●Expectations: He wants to know what it is and be told what to do, and reassurance if it is safe. "I want to know if it's serious and exactly what to do."
If Asked — Serious-Rash / Meningococcal / Traffic-Light Screen
The caller answers these only when directly asked; he can perform a guided glass test.
- ●If asked about fever (and how high/how she is with it): "A mild temperature, and she's fine in herself with it — not burning up."
- ●If guided to do the glass test (press a glass against the rash): "I've pressed a glass on it… yes, it fades and goes pale when I press." (Blanching — reassuring against a meningococcal/non-blanching rash.)
- ●If asked about the rash being non-blanching / dark red or purple spots / bruise-like marks: "No dark purple spots or bruises — it goes pale when pressed."
- ●If asked about drowsiness, floppiness, or being difficult to wake: "No, she's alert and lively."
- ●If asked about neck stiffness, dislike of bright light, or a bulging soft spot: "No neck stiffness, she's not bothered by light."
- ●If asked about cold hands and feet, mottled/pale skin, fast breathing, or a high-pitched/inconsolable cry: "Hands and feet are warm, colour's normal, breathing's fine, and she's not crying inconsolably."
- ●If asked about feeding/drinking and wet nappies/urine: "Eating and drinking normally, weeing normally."
- ●If asked about the rash's spread/speed and any blisters: "It came on today, hasn't obviously spread fast, no blisters."
- ●If asked about contacts/immunisations: "There's a bug going round nursery. Her jabs are all up to date."
Responses to Management (The Negotiation Phase)
- ●If the Doctor guides a glass test and screens for red flags: "So you want me to press a glass on it and check those warning signs? Okay, let me look." (The tested point is a structured remote red-flag/meningococcal screen, including the glass test.)
- ●If the Doctor is honest that the rash can't be seen: "You can't be certain without seeing it? I understand." (The tested point is honesty about the limits of telephone assessment — no false reassurance.)
- ●If the Doctor problem-solves getting her seen (if needed): "If she needs to be seen, I could ask my neighbour to drive us, or get a taxi. What do you think?" (The tested point is a safe disposition that is not defeated by the logistical barrier.)
- ●If the Doctor gives a strong safety-net: "What exactly should I watch for, and when do I ring 999?" (The tested point is a clear, specific safety-net.)
- ●If the Doctor offers review: "Should I bring her in if it changes, or ring back?"
Mark Scheme
Domain 1: Data Gathering and Diagnosis
Domain 2: Clinical Management and Medical Complexity
Domain 3: Relating to Others
Clinical Learning Points
Remote Rash Assessment — Know the Limits
- ●A rash cannot be seen on a telephone call. The safe approach is to gather what history you can, screen thoroughly for red flags, avoid false reassurance, and set the disposition and safety-net accordingly — with a low threshold to see the child.
The Meningococcal/Serious-Rash Screen
- ●Screen for a non-blanching/purpuric rash (guide a glass/tumbler test), fever, drowsiness/floppiness, neck stiffness, photophobia, bulging fontanelle, cold peripheries, mottled/pale skin, fast breathing, and an inconsolable/high-pitched cry. Any of these → emergency assessment (999).
Assess How Unwell the Child Is
- ●Use the "traffic-light" markers — activity/alertness, feeding/drinking, urine output, colour, breathing — to judge how unwell the child is, not just the rash itself.
Safe Disposition Despite Barriers
- ●Do not let a lack of transport or a photo dictate an unsafe advice-only outcome. If the child needs to be seen, problem-solve (relative/neighbour, taxi, arrange a visit) — and for meningococcal concern, arrange a 999 ambulance. Safety comes first.
Interim Advice and a Strong Safety-Net
- ●For a well child with a viral picture, give sensible interim advice (fever management, fluids, monitoring) and a clear, specific safety-net with the exact red flags and when to call 999 — repeated and checked.
Documentation
- ●Document the history, negative red flags, glass-test result, advice, and safety-net — important in any remote, unsighted assessment.
Paediatric Caution
- ●Apply extra caution in a young child with fever and a rash, where deterioration can be rapid, and keep the threshold for review low.
Common Candidate Mistakes in This Case
- ●False reassurance: declaring it "just a viral rash" without having seen it.
- ●Skipping the red-flag/glass-test screen: missing the meningococcal screen.
- ●Being defeated by logistics: giving advice only because the child cannot easily attend, when she needs to be seen.
- ●Weak safety-netting: vague or absent red-flag advice in a remote paediatric assessment.
- ●No review or documentation: no low-threshold review plan, or no record of the unsighted assessment.