Man Complaining About the Care His Mother Received From Another GP — Free SCA Practice Case
Man complaining about the care his mother received from another GP
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
Elizabeth Ellison
Age
78 years
Consultation Type
VideoAge
78
Situation
Video Consultation, booked by the patient's son to raise concerns.
Reason for Encounter
"I want to talk about the way my mother was treated by one of your doctors two weeks ago. I'm not happy about it."
Medical Records (Elizabeth Ellison)
- ●PMH: Osteoarthritis (right knee). Hypertension.
- ●Medications: Amlodipine 5 mg OD. Amitriptyline 25 mg nocte — started 2 weeks ago. Topical ibuprofen.
- ●Allergies: NKDA.
- ●Consultation 2 weeks ago (Dr Barnes): "Recent X-ray confirms osteoarthritis of right knee. Pain not controlled with topical ibuprofen; sometimes affects her at night. No red flags. Plan: start amitriptyline 25 mg nocte. Worsening advice given." No examination documented.
Patient Script
For the friend playing the patient role
Character Overview: You are Gary, 52, son of Elizabeth, who is 78 and lives alone in her own home. She is mentally sharp and independent. Two weeks ago she saw Dr Barnes about her knee. You drove her and sat in on the consultation. You were concerned that the doctor looked exhausted — red eyes, yawning, appeared not to have slept — and rushed the appointment; he did not examine her knee at all, which surprised you as previous doctors always had. He started her on amitriptyline. Since then she has been dizzy and unsteady, and last week she stumbled on the stairs and grabbed the bannister — she did not fall, but it frightened you both. She stopped the tablet three days ago on your advice and the dizziness has settled. You looked amitriptyline up and found it is an antidepressant, which you feel was inappropriate. You are not litigious but you want it taken seriously, you want to know how to make a formal complaint, and — most importantly to you — you are worried about the other patients that doctor saw that day. Your mother knows you are making this call and is content for you to discuss her care.
Opening Sentence: "Thanks for seeing me, Doctor. I want to raise concerns about my mother's appointment two weeks ago with Dr Barnes. Frankly, the man looked like he hadn't slept in days. He rushed her, he didn't examine her knee at all, and he put her on a tablet that's made her dizzy — she nearly came down the stairs. I want to know how I make a complaint, and honestly I'm worried about the other patients he saw that day."
History if Asked (Data Gathering Phase)
- ●What happened: "He looked exhausted — red eyes, yawning, kept losing his thread. The appointment was over in a couple of minutes. He didn't examine her knee at all."
- ●The medication: "He started her on amitriptyline. She's been dizzy and unsteady ever since."
- ●The near-fall: "Last week she stumbled on the stairs and grabbed the bannister. She didn't fall, but she could have. She's 78."
- ●Since stopping: "I told her to stop it three days ago. The dizziness has settled since."
- ●What he found out: "I looked it up. It's an antidepressant. She's not depressed — she's got a bad knee."
- ●His mother's consent: "She knows I'm ringing. She's happy for you to discuss it with me. She's completely with it, mentally."
- ●What he wants: "I want to know how to complain properly. And I want to know whether that prescription was right. But mostly — what about the other patients he saw?"
ICE — Ideas, Concerns, Expectations
The caller does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.
- ●Ideas: Gary believes Dr Barnes was not fit to be working that day and that the prescribing decision was wrong. "I don't think that man was fit to be seeing patients."
- ●Concerns: His dominant concern is the safety of other patients seen that day; he is also worried about his mother's fall risk and feels she was not treated with proper care. "It's the other patients I keep thinking about. And Mum could have broken a hip."
- ●Expectations: He wants to know how to make a formal complaint, and wants an answer on whether the prescription was appropriate. "Tell me how to complain, and tell me straight whether that tablet was the right call."
If Asked — Clinical, Consent, and Complaint Screen
The caller answers these only when directly asked.
- ●If asked about his mother's current condition — the immediate priority: "She's better since stopping the tablet. The dizziness has gone. Her knee still hurts though, and nothing's been sorted for that."
- ●If asked about whether she actually fell, or sustained any injury: "She didn't fall — she caught herself on the bannister. No injury. But it was close."
- ●If asked about ongoing dizziness, confusion, or other side effects: "No, all settled since she stopped it."
- ●If asked about her knee pain now: "Still painful, especially at night. She's back to just the gel, which doesn't work."
- ●If asked about his mother's capacity and consent — key: "She's sharp as a tack. She knows I'm speaking to you and she's happy for you to discuss her care with me."
- ●If asked whether his mother would like to be involved directly: "She'd be happy to speak to you as well. She just finds phone calls hard — she'd rather I did the talking."
- ●If asked what specifically made him think the doctor was unwell: "Red eyes, yawning repeatedly, losing his train of thought, and rushing. It was like he was somewhere else."
- ●If asked about whether he has raised this with anyone else: "No, I came straight to you."
- ●If asked about what outcome he wants: "An explanation, an apology for how she was treated, and for someone to make sure that doctor is fit to work."
- ●If asked about whether he wants to take it further formally: "Yes, I want to know how the formal route works."
Responses to Management (The Negotiation Phase)
- ●If the Doctor addresses the immediate clinical safety first: "You want to sort her knee out and check she's alright first? Yes — that's fair enough, that matters more." (The tested point is prioritising the patient's clinical safety over the complaint process.)
- ●If the Doctor confirms consent before discussing details — key: "You need to be sure Mum's happy for you to discuss her care with me? Of course. She is." (The tested point is checking consent/confidentiality before discussing a competent adult's medical details with a relative.)
- ●If the Doctor apologises for the experience without apportioning blame: "Thank you. I'm not out to get anyone — I just wanted it acknowledged." (The tested point is a genuine apology for the experience that is not an admission of liability or a criticism of the colleague.)
- ●If the Doctor is asked directly whether the prescribing was wrong: "So — was amitriptyline the right thing to give a 78-year-old for a bad knee?" (The tested point is answering honestly and factually about the medication and its risks in older people, without passing judgement on the colleague or pre-empting an investigation.)
- ●If the Doctor explains the complaints process: "So I put it in writing to the practice manager, and there's a timescale, and if I'm not happy there's an ombudsman? That's what I needed."
- ●If the Doctor addresses the concern about the colleague: "So you'll make sure someone senior looks at whether he was fit to work? That's the bit that matters most to me." (The tested point is taking a colleague-health/patient-safety concern seriously and escalating it appropriately, without discussing the colleague's personal circumstances.)
Mark Scheme
Domain 1: Data Gathering and Diagnosis
Domain 2: Clinical Management and Medical Complexity
Domain 3: Relating to Others
Clinical Learning Points
Patient Safety Comes Before Process
- ●When a complaint is raised, the first clinical priority is the patient: how are they now, is there ongoing harm, and what care do they still need? Here, the amitriptyline has been stopped, a falls risk has emerged, and the knee pain remains untreated — all of which need addressing alongside the complaint.
Confidentiality When a Relative Complains
- ●Where a competent adult is the patient, their consent is required before discussing their care with a relative — even a well-motivated one acting on their behalf. Establish and document consent, and consider involving the patient directly.
Neither Defend Nor Blame — the Central Balance
- ●Do not defend the indefensible, and do not criticise or speculate about a colleague to a complainant. Acknowledge the concerns, apologise for the experience, explain that the matter will be properly investigated by those responsible, and let the process reach findings.
Apology Is Not Admission
- ●A sincere apology that a patient's experience fell short is appropriate, expected, and not an admission of legal liability. Refusing to apologise typically escalates complaints.
The Complaints Process
- ●Explain the practice complaints procedure (how, to whom, timescales for acknowledgement and response), that a complaint may be made on a patient's behalf with their consent, the availability of PALS and independent advocacy, and the escalation route to the Parliamentary and Health Service Ombudsman.
The Duty-of-Candour Boundary
- ●The statutory duty of candour is an organisational duty triggered by notifiable safety incidents causing harm, discharged through the practice's processes with a formal apology, explanation, and record. It is not a licence for an individual clinician to make findings or admissions about a colleague's conduct while handling a complaint.
Concerns About a Colleague's Fitness Must Be Escalated
- ●A concern that a colleague may be unwell or impaired is a patient-safety issue. GMC guidance requires that it be raised promptly with an appropriate senior person (partners, clinical lead, responsible officer). The colleague's own health and personal circumstances remain confidential and must not be discussed with the complainant.
Common Candidate Mistakes in This Case
- ●Discussing the patient's care without her consent: a confidentiality breach, however well-intentioned the son.
- ●Becoming defensive, or joining in criticising the colleague: the two opposite failures of professional balance.
- ●Refusing to apologise, or refusing to answer the direct question: both confirm the family's suspicion of a closing of ranks.
- ●Ignoring the concern about the colleague's fitness: failing to escalate a genuine patient-safety issue.
- ●Forgetting the patient: handling the complaint but leaving the near-fall, falls risk, and untreated knee pain unaddressed.