Ms Signed Off Work and Worried About Money — Free SCA Practice Case

Character Overview: You are Laura, a 30-year-old administrator with relapsing–remitting MS, diagnosed three years ago. Over the last couple of weeks your right arm has become weak and clumsy — you can't type or lift properly — which you recognise as an MS relapse. You were signed off work a week ago. You are self-conscious about the impact on your job and, most of all, frightened about money: you have limited sick pay and are worried about paying your rent. You are otherwise coping but the stress is getting to you. You want your fit note sorted and to know what financial help you can get. You are articulate and pragmatic.

Opening Sentence: "Hi Doctor. My MS has flared up — my right arm's gone weak and clumsy, I can't really type or lift things. I got signed off last week. Honestly, my biggest worry is money — I don't get much sick pay and I'm scared about my rent. I need to sort my sick note and find out what I'm entitled to."

History if Asked (Data Gathering Phase)

• ●The relapse: "My right arm's weak and clumsy — came on over a couple of weeks. I can't type properly or carry things. It feels like a relapse; I've had them before."
• ●Other symptoms: "Mostly the arm this time. A bit of the usual fatigue."
• ●MS background: "Relapsing MS, diagnosed three years ago. I'm on a disease-modifying treatment through the MS team."
• ●Work: "I'm an administrator — lots of typing and filing. I can't do that with my arm like this. I've been signed off."
• ●Money — the main worry: "That's what's really frightening me. My sick pay is limited and I'm worried about paying the rent. I don't know what help I can get."

ICE — Ideas, Concerns, Expectations

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

• ●Ideas: Laura recognises this as an MS relapse and assumes she simply needs to be signed off until it settles. "I know it's a relapse. I assumed I'd just be signed off until my arm improves."
• ●Concerns: Her dominant concern is money — sick pay and rent — and, underneath, the impact of MS on her job security and future. "My real fear is money — the rent, the bills. And whether my MS will cost me my job."
• ●Expectations: She wants her fit note sorted and to know what financial support she can access. "I want my sick note dealt with and to find out what I'm entitled to."

If Asked — Relapse, Pseudo-Relapse, and Impact Screen

The patient answers these only when directly asked.

• ●If asked about the pattern of relapse (typical for her): "It's like previous relapses — a new symptom coming on over days to weeks."
• ●If asked about infection/fever/urinary symptoms (pseudo-relapse trigger): "No temperature, no burning or urinary symptoms, no cough." (No infection to trigger a pseudo-relapse.)
• ●If asked about other neurological symptoms (visual, sensory, balance, bladder/bowel, swallowing): "Mainly the arm. No new visual or balance problems, no bladder or bowel changes."
• ●If asked about fatigue, mood, and how she's coping: "The usual MS fatigue. My mood's been low with the stress of it all — the money especially."
• ●If asked about whether she's contacted the MS team: "Not yet for this one — I came to you first."
• ●If asked about her job and possible adjustments: "It's mostly typing and filing. I suppose some tasks could be adapted, but I've not discussed it with work."
• ●If asked about her financial situation in detail: "Limited sick pay, rent to pay, and savings running low. I don't really know what benefits exist."
• ●If asked about support at home: "I live alone. My family are supportive but not local."

Responses to Management (The Negotiation Phase)

• ●If the Doctor addresses the relapse and MS-team liaison: "So you want to make sure it's a genuine relapse and get the MS team involved? That makes sense." (The tested point is managing the relapse, excluding a pseudo-relapse, and liaising with the MS team.)
• ●If the Doctor discusses the fit note thoughtfully (adjustments/phased return): "So instead of just signing me off completely, we could look at adjustments so I could maybe do some work? I hadn't thought of that." (The tested point is a thoughtful fit-note strategy, including "may be fit for work" with adjustments.)
• ●If the Doctor signposts financial support — her main concern: "There's actual help I can claim — like PIP? And someone who can advise me? That's a huge relief." (The tested point is benefits signposting, e.g. PIP/ESA/Universal Credit and welfare-rights advice.)
• ●If the Doctor mentions employment rights/occupational health: "My employer has to make reasonable adjustments? And occupational health could help?" (The tested point is awareness of Equality Act duties and occupational health.)
• ●If the Doctor addresses her mood/wellbeing and support: "It has been getting me down. Is there support for that too?"