Man From the Gypsy and Traveller Community Disengaged From His Diabetes Care — Free SCA Practice Case

Character Overview: You are Michael, a 51-year-old man from the Traveller community, living in a caravan and temporarily registered with this practice. You had blood tests because you were tired and had put on weight; otherwise you feel well. You are moving out of the area tomorrow with your family and are not yet sure where you'll settle. Your diet is poor — lots of fast food, little cooking, because of life on the move. Your father had diabetes and died. You are more worried about diabetes than anything (a friend lost his foot to it). You want to know what the results show and what to do. You live this way by choice and are content with it; you do not want help with housing. You are friendly but have had mixed experiences with health services and will engage well if treated with respect and without being judged or lectured.

Opening Sentence: "Hello Doctor. I'm ringing about my blood results. I've been really tired and I've put weight on, so they took some blood. What did it show? I'll be straight with you — we're moving on tomorrow, so I've not got long."

History if Asked (Data Gathering Phase)

• ●Symptoms: "Tired all the time for a few months, and I've put on weight. Otherwise I feel alright in myself."
• ●Diet/lifestyle: "I'll be honest, my diet's poor — a lot of fast food, I don't really cook. It's hard living in a caravan, always on the move."
• ●Family history: "My dad had diabetes. He died."
• ●Moving on: "We're moving out of the area tomorrow. Not sure where we'll end up yet."
• ●What he wants: "I want to know what the results show and what I should do — before we move."

ICE — Ideas, Concerns, Expectations

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

• ●Ideas: Michael was told it might be his thyroid or diabetes. "The other doctor said it could be my thyroid or diabetes."
• ●Concerns: He is most worried about diabetes, because a friend lost his foot to it. "It's diabetes I'm frightened of — a mate of mine lost his foot with it."
• ●Expectations: He wants to know the results and what to do next, given he's moving. "I want to know what it is and what to do, especially as we're moving on."

If Asked — Diabetes Symptom, Complication, and Barrier Screen

The patient answers these only when directly asked.

• ●If asked about thirst, urinary frequency, and appetite (hyperglycaemia): "Yes, I've been thirstier and weeing more, now you mention it."
• ●If asked about blurred vision: "My vision's been a bit blurry sometimes."
• ●If asked about tingling/numbness in the feet, non-healing wounds, or foot problems (neuropathy/foot risk): "No numbness or sores on my feet that I've noticed."
• ●If asked about chest pain or breathlessness (cardiovascular): "No chest pain or breathlessness."
• ●If asked about weight change: "I've put weight on over a few months."
• ●If asked about smoking/alcohol: "I don't smoke and I don't drink."
• ●If asked about diet in detail: "Fast food mostly, sugary drinks, not much cooking — it's the lifestyle."
• ●If asked about how long he'll be in the area / continuity: "We move tomorrow. I don't know where we'll settle next."
• ●If asked (respectfully) about support with housing/social needs: "No thanks — we live this way by choice and we're happy with it."
• ●If asked about past experiences of healthcare: "Mixed, to be honest. Sometimes you feel judged, or it's hard to get seen when you're moving about."

Responses to Management (The Negotiation Phase)

• ●If the Doctor explains the diagnosis of type 2 diabetes clearly and respectfully: "So it is diabetes. Right. What does that actually mean for me?" (The tested point is explaining the diagnosis clearly and sensitively, engaging him.)
• ●If the Doctor gives realistic lifestyle advice suited to his life: "I can't cook much on the move — but cutting the sugary drinks and choosing better when I get fast food, I could manage that." (The tested point is practical, realistic lifestyle advice tailored to caravan living, not a generic lecture.)
• ●If the Doctor addresses continuity/records given he's moving — key: "How do I carry on with this when we move? Will the next place know?" (The tested point is ensuring continuity — records transfer, re-registration, giving him his results/summary.)
• ●If the Doctor respects his autonomy about his lifestyle: "I'm glad you're not trying to change how we live — we're happy as we are." (The tested point is respecting his lifestyle and autonomy, not imposing.)
• ●If the Doctor arranges follow-up structures (foot/eye/bloods): "So there are checks I'll need — my eyes, feet, bloods? I'll try to keep on top of it."