Cases/Respiratory Health

Severe COPD Asking for Home Oxygen Like His Friend Has — Free SCA Practice Case

Man with severe COPD asking for home oxygen like his friend has

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

Colin Merrick

Age

68 years

Consultation Type

Telephone

Age

Situation

Telephone Consultation.

Reason for Encounter

"I want to be put on oxygen at home. My friend at the breathing group has it and he says it's made all the difference."

Medical Records

●PMH: COPD (severe; FEV₁ 34% predicted on spirometry 8 months ago). Hypertension.
●Medications: Salbutamol inhaler PRN; long-acting bronchodilator inhaler (single agent); amlodipine.
●Allergies: NKDA.
●Recent notes: Two exacerbations in the past year, both treated in the community. Current smoker (~15/day). Oxygen saturation 93% on air at last review (stable state). Pulmonary rehabilitation offered 18 months ago — did not attend. No annual review in the past 14 months. Influenza and pneumococcal vaccination status not up to date.

Patient Script

For the friend playing the patient role

Character Overview: You are Colin, a 68-year-old retired dock worker with severe COPD. You get very breathless walking to the corner shop and have had to give up your allotment, which upsets you. You attend a local breathing support group where a friend has home oxygen, and he tells you it has transformed things for him — so you have decided that is what you need. You still smoke about 15 a day; you have tried to stop twice before and you are defensive if you feel lectured. You were offered pulmonary rehabilitation about 18 months ago but did not go — you thought exercise would make the breathlessness worse. You are frustrated and want action today. If the doctor explains things clearly and does not simply refuse you, you will engage.

Opening Sentence: "Hello Doctor. I want to get oxygen at home. My mate from the breathing group has it and he says it's made all the difference to him. I'm getting breathless just walking to the shop. Can you sort it out for me?"

History if Asked (Data Gathering Phase)

●His breathlessness: "Breathless walking to the corner shop — I have to stop. I've had to give up my allotment, which I'm gutted about."
●Why he wants oxygen: "My friend at the group has it and swears by it. I want the same."
●Smoking: "I still smoke, about 15 a day. I've tried stopping twice. Don't lecture me about it."
●Pulmonary rehabilitation: "They offered me some exercise programme a while back. I didn't go — I thought exercise would just make the breathlessness worse."
●Inhalers: "I've got the blue one and a brown-ish one I take each day. I'm not sure I use them right, truthfully."
●What he wants: "Oxygen. Today, if possible."

ICE — Ideas, Concerns, Expectations

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

●Ideas: Colin believes oxygen will relieve his breathlessness, based on his friend's experience. "I think oxygen will stop me being so breathless — it's worked for him."
●Concerns: His dominant concerns are his worsening breathlessness and loss of independence (the allotment, going out), and a fear that he is deteriorating. "I'm frightened I'm going downhill and losing what I can still do."
●Expectations: He expects home oxygen to be arranged. "I want you to arrange the oxygen."

If Asked — COPD Assessment and Hypoxaemia Screen

The patient answers these only when directly asked.

●If asked about exercise tolerance/MRC breathlessness grade: "I can manage maybe fifty yards on the flat before I have to stop. Stairs are terrible."
●If asked about exacerbation frequency and treatment: "Two bad chest episodes last year, both treated at home with steroids and antibiotics. No hospital admissions."
●If asked about sputum, colour change, or haemoptysis: "A bit of clear phlegm most mornings. No blood."
●If asked about weight loss, appetite, or night sweats: "No weight loss, appetite's alright, no sweats." (Reassuring against malignancy.)
●If asked about ankle swelling, orthopnoea, or morning headaches: "No ankle swelling, I sleep on one pillow, no morning headaches." (No cor pulmonale/hypercapnia features.)
●If asked about chest pain: "No chest pain."
●If asked about inhaler technique and adherence: "I take the daily one most days. Nobody's checked how I use them for years, and I do wonder if I'm doing it right."
●If asked about smoking, and readiness to stop: "Fifteen a day. I've tried twice. I suppose I would try again if there was proper help."
●If asked about anyone else smoking in the home / oxygen fire risk: "Just me smoking. My wife doesn't."
●If asked about vaccinations: "I don't think I've had my flu jab for a couple of years."
●If asked about mood and social impact: "It gets me down, being stuck in. I miss the allotment and the company."
●If asked about what his friend's oxygen is for: "I don't really know the ins and outs of his case, to be fair."

Responses to Management (The Negotiation Phase)

●If the Doctor explains what oxygen is and is not for — the key misconception: "So oxygen isn't actually a treatment for feeling breathless? It's for low oxygen levels in the blood? I didn't realise that." (The tested point is correcting the misconception that LTOT relieves breathlessness.)
●If the Doctor explains the assessment criteria: "So there's a proper assessment with blood tests, and only some people qualify? How do we find out if I do?" (The tested point is explaining LTOT assessment criteria and arranging appropriate assessment rather than refusing outright.)
●If the Doctor raises smoking as a contraindication — key: "You're saying they wouldn't give me oxygen while I'm smoking? Because of fire? I hadn't thought of that at all." (The tested point is explaining the fire-safety contraindication honestly and non-judgementally, and linking it to cessation support.)
●If the Doctor recommends pulmonary rehabilitation: "The exercise programme again? I thought it would make me worse. You're saying it's the thing most likely to help my breathing?" (The tested point is redirecting him to the intervention with the strongest benefit for breathlessness and quality of life.)
●If the Doctor offers inhaler review and optimisation: "So my inhalers might not be right, or I might not be using them properly? Worth checking, I suppose."
●If the Doctor arranges a full review: "So a proper check-up — my breathing tests, jabs, and the rest?"

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 18 indicators checked+0−0

Positive (0/9)

Negative (0/9)

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

What Long-Term Oxygen Therapy Is For

●LTOT treats chronic hypoxaemia to improve survival — it is not a treatment for breathlessness. Patients (and their peers) frequently misunderstand this; correcting the misconception is central to the consultation.

LTOT Assessment Criteria

●LTOT is prescribed only after formal arterial blood-gas assessment in the clinically stable state, on two separate occasions several weeks apart, where the oxygen level is persistently low — with a higher threshold applying where there is polycythaemia, peripheral oedema, or pulmonary hypertension. It must be used for a minimum number of hours per day to confer benefit. Assessment is via the home-oxygen service, not prescribed on request.

Smoking Is a Contraindication — Fire Safety

●Continued smoking is a contraindication to home oxygen because of the serious fire and burn risk. Explain this honestly and non-judgementally, and make smoking-cessation support the route towards the patient's goal rather than a reproach.

Pulmonary Rehabilitation Is the Highest-Value Intervention for Breathlessness

●Pulmonary rehabilitation has the strongest evidence for improving breathlessness, exercise capacity, and quality of life in COPD. Many patients believe exercise will worsen breathlessness — addressing that belief directly is often the single most valuable thing achieved in the consultation.

Optimise Inhaled Therapy and Technique

●Review inhaled therapy against NICE NG115 (escalating from single long-acting bronchodilator to dual/triple therapy where breathlessness or exacerbations persist) and always check inhaler technique — a common, correctable cause of apparent treatment failure.

Complete Routine COPD Care

●Provide a full annual review: spirometry, symptom/breathlessness scoring, vaccinations, a self-management and rescue plan, exacerbation review, smoking cessation, and nutrition/mood assessment. Consider ambulatory oxygen only via specialist assessment.

Address Mood, Isolation, and Function

●Severe COPD commonly brings low mood, isolation, and loss of valued activities. Address these with social prescribing and support, and shape the plan around restoring function.

Common Candidate Mistakes in This Case

●Simply refusing the request: denying oxygen without explanation, assessment, or an alternative plan.
●Agreeing to arrange oxygen inappropriately: acceding to the request without understanding the criteria.
●Not mentioning the fire-safety contraindication: omitting a central safety issue, or raising it punitively.
●Missing pulmonary rehabilitation: failing to re-refer or to tackle the belief that exercise worsens breathlessness.
●Neglecting inhaler optimisation and routine care: overlooking suboptimal therapy, technique, vaccinations, and the overdue review.

Free MRCGP SCA practice case for GP registrars covering Severe COPD Asking for Home Oxygen Like His Friend Has — Respiratory Health. 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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