Cases/Prescribing

Man Asking the Practice to Remove An Entry From His Medical Records — Free SCA Practice Case

Man asking the practice to remove an entry from his medical records

Station Timer

12:00

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

12:00

Golden Minute

Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Amir Qureshi

Age

48 years

Consultation Type

Telephone

Age

Situation

Telephone Consultation. Recently re-registered with the practice.

Reason for Encounter

"I've noticed hepatitis C is still on my records. I'd like it taken off."

Medical Records

●PMH: Hepatitis C — diagnosed 8 years ago; treated with direct-acting antiviral therapy 7 years ago.
●Medications: None currently.
●Allergies: NKDA.
●Notes: Recently re-registered following several years working overseas. Hospital records indicate antiviral treatment was completed, but the patient did not attend the post-treatment appointment at which sustained virological response would have been confirmed. No documented test of cure. No liver function tests or hepatitis C RNA results on file for the past 7 years.

Patient Script

For the friend playing the patient role

Character Overview: You are Amir, 48. You were diagnosed with hepatitis C eight years ago and treated successfully with antiviral tablets seven years ago. You were under a hospital specialist at the time, but you moved abroad for work and missed some of your follow-up appointments. You have recently returned to the UK and started a new job as a restaurant manager. Filling in a medical history form for the job made you notice hepatitis C is still on your record, and you want it removed — you are worried it could affect your job. You feel completely well with no symptoms. You do not smoke, drink, or use drugs. You live alone but have recently started a new relationship with a man. You are polite but firm about wanting the entry deleted, and you will be frustrated if simply told no. You have two questions you want answered: is it safe to have sex without condoms now, and would hepatitis C stop you working as a restaurant manager.

Opening Sentence: "Hello Doctor. I've just started a new job and had to fill in a medical form, and I noticed hepatitis C is still on my medical records. I was treated for that seven years ago and I'm fine now. I'd like it taken off my records, please."

History if Asked (Data Gathering Phase)

●The diagnosis and treatment: "Diagnosed eight years ago, treated with antiviral tablets seven years ago. The hospital looked after me at the time."
●The follow-up — if asked: "I moved out to Dubai for work and I missed some of the follow-up appointments. I assumed it was all done and dusted."
●How he is now: "Completely well. No symptoms at all."
●Why now: "The medical form for my new job. I'm a restaurant manager. Seeing it written down worried me."
●What he wants: "I want it removed. It was treated. It's in the past."
●His questions: "Two things I want to ask — is it safe to have sex without a condom now? And could hepatitis C stop me working in a restaurant?"

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.

●Ideas: Amir believes that because the infection was treated years ago and he has no symptoms, it should no longer appear on his record. "It was treated. It's history. Why should it still be written down?"
●Concerns: His dominant concern is that the entry will affect his employment; underneath, there is stigma and embarrassment about the diagnosis. "I'm worried it'll cost me the job. And honestly, I don't want people knowing."
●Expectations: He expects the entry to be deleted. "I want it taken off."

If Asked — Clinical, Risk, and Record Screen

The patient answers these only when directly asked.

●If asked about symptoms of liver disease (jaundice, itching, abdominal pain, pale stools, dark urine, swelling, confusion): "None of those. I feel completely well."
●If asked about whether cure was ever confirmed — key: "I don't think I ever had the final test. I'd moved abroad by then. Nobody has ever told me definitively that it had cleared."
●If asked about blood tests since treatment: "None that I know of, not for years."
●If asked about how he acquired it: "They thought it was from a tattoo I had done abroad years ago."
●If asked about injecting drug use, alcohol, or smoking: "No drugs, ever. I don't drink and I don't smoke."
●If asked about his new relationship and sexual health: "I've recently started seeing someone — a man. That's why I asked about condoms."
●If asked about previous sexual health screening or hepatitis A/B vaccination: "I don't think I've ever had a full screen, and I don't know about vaccinations."
●If asked about whether the employer's form asks specifically about hepatitis C or just general medical history: "It's a general medical history form — it doesn't single anything out."
●If asked whether he believes the entry is factually wrong: "No, I did have it. I just don't want it on there now it's treated."
●If asked about family/household members who might need testing: "I live alone. No one at risk that I can think of."

Responses to Management (The Negotiation Phase)

●If the Doctor explains the entry cannot be deleted — key: "So you can't just take it off? Why not — it's my record." (The tested point is declining the deletion clearly, with reasons, rather than agreeing or simply refusing.)
●If the Doctor explains record integrity and patient safety: "So if I got ill in future, a doctor would need to know I'd had it? I hadn't thought of it that way." (The tested point is explaining why record integrity matters for his own safety.)
●If the Doctor explains rectification rights — key: "So if something were factually wrong I could have it corrected, and I can add my own statement if I disagree? That's useful to know." (The tested point is explaining the right to rectification and the option of adding a statement of disagreement.)
●If the Doctor offers to test and update the record accurately — the constructive resolution: "So if a blood test shows it's cleared, you can record that clearly — that it's been treated and cured? That's actually what I want." (The tested point is finding the legitimate way to meet his underlying need.)
●If the Doctor answers the restaurant question: "So hepatitis C isn't passed on through food, and it wouldn't stop me managing a restaurant? That's a relief."
●If the Doctor answers the sex question: "So until we've confirmed it's cleared, I should use condoms — and then we review it?"

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 20 indicators checked+0−0

Positive (0/10)

Negative (0/10)

Domain 2: Clinical Management and Medical Complexity

0 / 20 indicators checked+0−0

Positive (0/10)

Negative (0/10)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

Accurate Records Cannot Be Deleted on Request

●The medical record must be a complete, accurate, contemporaneous account of a patient's health. Deleting an accurate historical entry — however unwelcome to the patient — would compromise record integrity and patient safety, and would breach the probity and record-keeping obligations in GMC Good Medical Practice.

Rectification Rights — What Patients Can and Cannot Do

●Under UK data protection law, patients have the right to have factually inaccurate personal data corrected. However, a record of a past diagnosis is not "inaccurate" simply because the patient dislikes it, and a clinical opinion recorded at the time is not inaccurate merely because it is disputed. Where a patient disagrees, a statement of their disagreement can be added to the record, and practices should have a formal process for handling such requests.

Look for the Need Behind the Request

●Requests to amend records are usually driven by employment, insurance, immigration, or stigma concerns. Identifying the underlying need often reveals a legitimate way to help — which is far more useful than a bare refusal.

An Unconfirmed Cure Is a Clinical Gap

●Hepatitis C cure is confirmed by a sustained virological response — an undetectable HCV RNA at the defined interval after treatment. Where follow-up was missed, cure is assumed rather than proven. Testing HCV RNA and liver function both closes a genuine clinical gap and allows the record to be updated accurately to reflect treated and cleared infection.

Hepatitis C Transmission and Occupational Advice

●Hepatitis C is blood-borne, not transmitted through food, water, or casual contact — it does not preclude work in catering or hospitality. Occupational restrictions apply only to exposure-prone procedures in healthcare. Sexual transmission is uncommon but not impossible; advise barrier protection until cure is confirmed, and offer a full sexual health screen and hepatitis A and B vaccination.

Preserve the Relationship When Saying No

●Declining a request is compatible with maintaining trust if the clinician explains the reasoning, acknowledges the feelings behind the request, answers the patient's actual questions, and offers a constructive alternative.

Document and Signpost the Formal Route

●Document the request and the response, and signpost the practice's formal process for record-amendment requests if the patient wishes to take it further.

Common Candidate Mistakes in This Case

●Agreeing to delete the entry: a serious probity and patient-safety failure.
●Refusing without explanation: leaving the patient feeling obstructed and damaging the relationship.
●Misstating the legal position: either implying records can never be changed, or that deletion can be demanded.
●Missing the unconfirmed cure: overlooking the clinical gap and the legitimate route to meeting his request.
●Not answering his direct questions: leaving the occupational and sexual-health concerns unaddressed, or giving inaccurate advice.

Free MRCGP SCA practice case for GP registrars covering Man Asking the Practice to Remove An Entry From His Medical Records — Prescribing. Includes candidate brief, patient script, marking scheme mapped to the RCGP SCA marking domains, and learning points. Built directly from the RCGP curriculum topic stations listed under "How this might be tested in the MRCGP SCA," part of a free library of 79 SCA practice cases for simulated consultation assessment preparation.

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