Cases/Gynaecology and Breast

Stepmother Wanting to Discuss Her 14-year-old Stepdaughter's Period Pains — Free SCA Practice Case

Stepmother wanting to discuss her 14-year-old stepdaughter's period pains

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

Millie Chapman

Age

14 years

Consultation Type

Telephone

Age

Caller's Name

Karen Chapman (age 44, stepmother)

Situation

Telephone Consultation. You are the duty GP. Millie's stepmother, Karen, has booked a call to discuss Millie's period pains and treatment options.

Reason for Encounter

"I want to talk about my stepdaughter Millie's periods — she gets terrible cramps every month and it's affecting school. I'd like to know what can be done and whether she can be started on something for it."

Medical Records (patient, Millie)

●PMH: Nil significant. Menarche around age 12.
●Medications: None recorded.
●Allergies: NKDA.
●Recent notes: No recent consultations. Registered at the practice; lives with father and stepmother.

Patient Script

For the friend playing the patient role

Character Overview: You are Karen, Millie's stepmother. You are warm, well-meaning, and genuinely concerned — you have largely taken on the day-to-day parenting and you want to help. You are not trying to overstep; you simply want to sort Millie's pain out for her. You are a little surprised if told there are limits to what can be discussed or done without Millie herself. You are entirely reasonable and cooperative once things are explained.

Opening Sentence: "Hi Doctor, thanks for calling. It's about my stepdaughter, Millie — she's 14. Every month she gets really bad period cramps, doubled over, and she's been missing school because of it. I do most of the looking-after, and I want to help her. I was hoping you could tell me what the options are and maybe start her on something."

History if Asked (Data Gathering Phase — gathered via the stepmother)

●The symptoms: "Crampy lower tummy pain that comes with her periods, the first day or two mostly. She curls up with a hot water bottle. It's been happening since her periods started, maybe a year and a half ago, and it seems to be getting worse."
●Impact: "She's missed a few days of school with it. She's tearful and in real pain. It's upsetting to watch."
●What's been tried: "Paracetamol, which barely touches it. A hot water bottle helps a bit."
●The bleeding: "Her periods are fairly regular, I think — I don't know all the details, to be honest. She's quite private about it."
●Why she's calling, not Millie or her dad: "Millie's at school, and her dad works long hours, so I said I'd sort it. I'm the one who's around for her."

ICE — Ideas, Concerns, Expectations

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

●Ideas: Karen thinks the period pains just need "something stronger" prescribed, and that as the parent-figure she can arrange this on Millie's behalf over the phone. "I assumed I could just describe it and you'd prescribe something for her, like when they were little."
●Concerns: Her genuine concern is Millie's suffering and missed schooling; she has no hidden agenda. She would be mildly taken aback, but understanding, if told Millie needs to be involved. "I just hate seeing her in that much pain and missing school. I want to fix it for her."
●Expectations: She expects to leave the call with a treatment or a prescription arranged. "I was hoping to come away with a plan, ideally something prescribed."

If Asked — Background and Safeguarding-Awareness Questions

The caller answers these only when directly asked.

●If asked about Millie's awareness of this call: "She knows I was going to ring, yes — she's happy for me to ask. She just hates talking about it herself and finds appointments embarrassing."
●If asked about who has parental responsibility: "Her dad does. I'm her stepmum — we've been together five years and I do most of the parenting, but I suppose legally I'm not her parent."
●If asked whether Millie could attend an appointment: "Yes, she could come after school, or her dad could bring her at the weekend. I just thought I'd save her the embarrassment."
●If asked about red-flag features (very heavy bleeding, pain outside periods, pain during sex, symptoms suggesting something more): "I don't think so — it's really the period cramps. I don't know about anything more than that; she keeps that side of things private."
●If asked whether there are any worries about Millie's wellbeing or home life: "No, nothing like that — she's a happy, settled girl. This is just the period pain."
●If asked about Millie's general health and school otherwise: "She's well and doing fine at school apart from these days off with the pain."

Responses to Management (The Negotiation Phase)

●If the Doctor explains they cannot fully assess or prescribe for Millie without involving her: "Oh — I assumed I could just sort it for her. Why do you need to speak to her directly?" (The tested point is explaining, kindly, that the patient is Millie, that she needs to be assessed and involved, and why — without making Karen feel rebuffed.)
●If the Doctor raises Millie's own confidentiality and views: "She's only 14 though — surely I'm entitled to know and decide about her care?" (The tested point is explaining confidentiality and the young person's own role in decisions, and the step-parent's position, tactfully.)
●If the Doctor offers general self-care advice now: "So what can she safely try in the meantime?"
●If the Doctor recommends an appointment for Millie: "Would she need to come on her own, or can I or her dad come with her?"
●If the Doctor asks why Karen is calling rather than Millie or her father: "Is it a problem that it's me ringing and not her dad?"

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 14 indicators checked+0−0

Positive (0/7)

Negative (0/7)

Domain 2: Clinical Management and Medical Complexity

0 / 18 indicators checked+0−0

Positive (0/9)

Negative (0/9)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

Third-Party Consultations About a Minor

●When an adult calls about a child, the patient is the child. A minor cannot be fully assessed or treated second-hand: a proper history, examination where needed, and the young person's involvement are required.
●Be warm about the caller's concern while being clear about the limits — the aim is the child's best interests, not bureaucracy.

Confidentiality and the Young Person's Voice

●Young people have their own right to confidentiality. Information about a competent young person should not be shared with a third party — even a parent or carer — without appropriate justification or the young person's agreement.
●A competent 14-year-old should be involved in decisions about her own care.

Gillick Competence and Consent

●A young person under 16 who has sufficient understanding and maturity — Gillick competent — can consent to their own treatment. Their capacity to be involved in, and consent to, care should be assessed directly.
●This is why the young person, not a third party, must be engaged for meaningful assessment and treatment.

Parental Responsibility and Step-Parents

●Parental responsibility determines who can consent on a child's behalf. A step-parent does not automatically acquire parental responsibility (it can be gained through marriage/civil partnership with agreement or a court order, or adoption).
●Handle this sensitively: a step-parent may be the main day-to-day carer even without legal parental responsibility.

Primary Dysmenorrhoea in Adolescents

●Painful periods beginning within a year or two of menarche, without other features, are usually primary dysmenorrhoea.
●Management ladder: NSAIDs (e.g. ibuprofen, mefenamic acid) first-line, taken with food and started ahead of or at the onset of pain; heat and lifestyle measures; and hormonal options (combined oral contraceptive or progestogen) where appropriate — after proper assessment and with the young person's involvement.

Considering Secondary Dysmenorrhoea

●Consider secondary causes (e.g. endometriosis, pelvic pathology) if the pain is atypical, started well after menarche, is worsening, occurs outside periods, or fails to respond to first-line treatment — features to screen for and safety-net.

Proportionate Safeguarding

●Remain alert to welfare concerns, but do not turn a benign, caring enquiry into a safeguarding investigation. Escalate only if genuine concerns emerge.

Common Candidate Mistakes in This Case

●Assessing and prescribing second-hand: treating and prescribing for Millie based solely on the stepmother's account, without involving the patient.
●Breaching confidentiality: sharing (or offering to share) Millie's confidential information with the stepmother.
●Assuming step-parent authority: treating the stepmother as having full parental responsibility without checking.
●Being cold or bureaucratic — or caving in: either alienating a well-meaning carer with rules, or abandoning appropriate limits to avoid awkwardness.
●Over- or under-playing safeguarding: manufacturing a safeguarding concern where none exists, or ignoring the welfare dimension entirely.

Free MRCGP SCA practice case for GP registrars covering Stepmother Wanting to Discuss Her 14-year-old Stepdaughter's Period Pains — Gynaecology and Breast. 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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