CASE INFORMATION

Case ID: GEN-010
Case Name: David Collins
Age: 52 years
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: A29 – General symptom/complaint, other

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages the patient to understand concerns, ideas, and expectations 1.2 Provides clear explanations tailored to the patient’s level of health literacy 1.4 Uses effective consultation techniques, including active listening and empathy
2. Clinical Information Gathering and Interpretation	2.1 Takes a thorough history to explore vague or non-specific symptoms 2.2 Selects appropriate investigations based on clinical presentation
3. Diagnosis, Decision-Making and Reasoning	3.1 Develops a broad differential diagnosis for non-specific symptoms 3.2 Identifies red flags requiring urgent intervention
4. Clinical Management and Therapeutic Reasoning	4.1 Develops a structured, patient-centred management plan 4.2 Provides advice on pharmacological and non-pharmacological management
5. Preventive and Population Health	5.1 Discusses lifestyle modifications and screening relevant to the presentation
6. Professionalism	6.1 Maintains patient confidentiality and demonstrates ethical practice
7. General Practice Systems and Regulatory Requirements	7.1 Documents accurately and ensures appropriate follow-up
9. Managing Uncertainty	9.1 Provides reassurance and safety-netting when the diagnosis is unclear
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises vague symptoms that may indicate an underlying serious condition

CASE FEATURES

Middle-aged male presenting with vague symptoms, including fatigue, mild dizziness, and generalised aches.
Broad differential diagnosis, considering benign causes, metabolic conditions, and serious underlying disease.
Exploring lifestyle factors, including stress, sleep, diet, and medical history.
Determining the need for investigations vs. reassurance and watchful waiting.
Addressing patient concerns about a possible serious illness (e.g., cancer, heart disease).

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face-to-face.

You are not required to perform an examination.

A patient record summary is provided for your information.

Perform the following tasks:

Take an appropriate history.
Outline the differential diagnosis and key investigations required.
Address the patient’s concerns.
Develop a safe and patient-centred management plan.

SCENARIO

David Collins, a 52-year-old office manager, presents with fatigue, occasional mild dizziness, and generalised muscle aches over the past three months. He describes himself as “just not feeling quite right” but struggles to pinpoint specific symptoms.

He has no major pain or neurological symptoms, but he feels more tired than usual, even after sleep. He has noticed some weight gain and wonders if his stressful job and poor diet are to blame.

PATIENT RECORD SUMMARY

Patient Details

Name: David Collins
Age: 52
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies

Medications

Nil regular medications

Past History

Borderline hypertension (not on treatment)
No history of diabetes or thyroid disorders

Social History

Works in a demanding office job, often working long hours.

Family History

Father had a heart attack at 60.
No family history of cancer, autoimmune diseases, or neurological disorders.

Smoking

Never smoked

Alcohol

Drinks 8-10 standard drinks per week

Vaccination and Preventative Activities

Last health check was 3 years ago

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

ROLE-PLAYER SCRIPT

Opening Line

“Doctor, I’ve been feeling off for a few months now. I can’t quite put my finger on it, but I just feel more tired and achy than usual. Could this be something serious?”

General Information

Your name is David Collins, and you are 52 years old.
You work as an office manager, a high-pressure role with long hours.
You haven’t had a proper health check in years and are starting to worry about your health.
You live with your wife and two adult children, and your wife has been nagging you to see a doctor.

Specific Information

(Reveal only when asked directly)

Background Information

For the past three months, you’ve felt more tired than usual.
You wake up feeling unrefreshed, even though you sleep for 6-7 hours a night.
You sometimes feel mildly dizzy, especially in the afternoon, but you haven’t fainted.
You’ve noticed generalised muscle aches, mainly in the shoulders, neck, and legs.
You feel mentally drained and struggle to concentrate in the afternoons.

Fatigue and Energy Levels

You used to work late and still feel okay, but now you get exhausted easily.
You don’t feel excessively sleepy during the day, just low in energy.
You haven’t had recent viral illnesses, such as COVID-19 or the flu.

Diet and Lifestyle

You eat a lot of processed and takeaway foods.
You drink alcohol most nights—usually 2-3 drinks after work.
You rarely exercise because work keeps you sitting at a desk most of the day.
You’ve gained about 5kg over the past year.

Work and Stress

Your job is stressful, and you often feel mentally overloaded.
You feel like your stress levels have increased over the past year.
You sometimes feel like you’re “running on empty”, but you push through because you have responsibilities.

Concerns and Expectations

You are worried this could be something serious, like cancer, heart disease, or diabetes.
Your father had a heart attack at 60, and you’re worried you might be heading in the same direction.
You want to know if you need blood tests, scans, or a full check-up.
You feel guilty about your lifestyle choices but don’t know where to start making changes.

Red Flag Symptoms (Reveal only when asked directly)

No chest pain, shortness of breath, or palpitations.
No unexplained weight loss or night sweats.
No numbness, tingling, or weakness in arms or legs.
No fevers or swollen lymph nodes.

Emotional Cues & Body Language

You appear concerned but not panicked.
If the doctor is uncertain or dismissive, you may press further:
- “Are you sure this isn’t something serious?”
If the doctor suggests stress or lifestyle factors, you might seem reluctant at first but will be open to practical advice.
If the doctor only recommends blood tests but no lifestyle advice, you may ask:
- “What can I do to actually start feeling better?”
If the doctor explains things well, you will feel reassured and motivated to make changes.

Questions for the Candidate

(Ask these naturally throughout the consultation.)

“Do you think this could be something serious, like cancer or a heart problem?”
“Do I need blood tests or a scan to check for anything?”
“Could my diet or stress be causing this?”
“How can I start feeling better? Should I take vitamins?”
“What if I don’t do anything—will this get worse?”
“If I make changes, how long before I see an improvement?”
“Should I cut back on alcohol, and if so, how much?”
“Is there anything I should be eating more of to improve my energy?”

Key Behaviours & Approach

You are concerned but open to guidance.
If the doctor doesn’t address the possibility of serious conditions, you will ask if you need tests for heart disease or cancer.
If the doctor only suggests medications, you may ask about diet and exercise.
If the doctor mentions lifestyle changes, you may ask for specific steps and realistic expectations.
If the doctor suggests stress management, you might say:
- “I know I should be less stressed, but I can’t just quit my job. What else can I do?”

Additional Context for the Role-Player

You are not expecting a quick fix, but you want practical, realistic advice.
You are not against making lifestyle changes, but you need clear guidance on where to start.
You are concerned about your long-term health, especially due to your family history of heart disease.
You don’t want to waste time on unnecessary tests, but you also don’t want to ignore a serious problem.

Role-Player Summary

This case assesses the candidate’s ability to:

Take a structured history, exploring vague symptoms while identifying red flags.
Provide a broad differential diagnosis, considering benign and serious causes.
Reassure the patient while appropriately investigating.
Offer practical lifestyle advice, including diet, exercise, and stress management.
Ensure appropriate follow-up, balancing watchful waiting vs. early intervention.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the patient, considering potential causes of vague generalised symptoms.

The competent candidate should:

Use open-ended questions to allow the patient to describe their fatigue, muscle aches, and dizziness.
Clarify the onset, duration, severity, and impact of symptoms on daily life.
Assess for red flags, such as weight loss, night sweats, fever, neurological symptoms, or cardiac issues.
Explore lifestyle factors, including diet, alcohol intake, stress levels, and physical activity.
Review medical history and family history, particularly cardiovascular disease, metabolic disorders, and autoimmune conditions.
Address patient concerns about serious illness, ensuring their worries about heart disease or cancer are appropriately explored.

Task 2: Formulate a differential diagnosis and explain it to the patient.

The competent candidate should:

Provide a structured differential diagnosis, categorising conditions into:
- Metabolic causes: Hypothyroidism, diabetes, iron deficiency, B12 deficiency.
- Cardiovascular causes: Early heart disease, postural hypotension.
- Psychological causes: Stress, burnout, depression.
- Inflammatory/autoimmune conditions: Polymyalgia rheumatica, early inflammatory arthritis.
Reassure the patient that while serious illness is unlikely, appropriate tests will be done to rule out major concerns.
Explain why lifestyle factors (diet, alcohol, sedentary behaviour) may contribute to symptoms.
Provide a logical plan for investigation and follow-up to ensure patient confidence.

Task 3: Address the patient’s concerns, including fear of serious illness and need for further testing.

The competent candidate should:

Acknowledge the patient’s fears about heart disease and cancer and provide a structured plan to address them.
Explain that blood tests (e.g., full blood count, iron studies, thyroid function, fasting glucose, lipids) can help identify underlying causes.
Discuss cardiovascular risk assessment, including the need for lifestyle modifications and possibly an ECG.
Reassure the patient that vague symptoms can often be multifactorial, with stress, poor sleep, and diet playing significant roles.
Offer realistic expectations for improvement, setting a clear follow-up plan.

Task 4: Develop an initial management plan, including investigation options, reassurance, lifestyle modifications, and follow-up.

The competent candidate should:

Order targeted investigations, including blood tests for metabolic and inflammatory markers, and an ECG if indicated.
Recommend lifestyle modifications, such as reducing alcohol intake, increasing exercise, and improving sleep hygiene.
Suggest stress management strategies, including relaxation techniques or referral for psychological support if needed.
Provide safety-netting advice, ensuring the patient knows when to return for worsening symptoms or concerning findings.
Arrange follow-up in 2-4 weeks, depending on test results and symptom progression.

SUMMARY OF A COMPETENT ANSWER

Takes a structured history, exploring symptoms, lifestyle, and red flags.
Provides a broad differential diagnosis, explaining why serious conditions are unlikely but warrant investigation.
Addresses patient concerns empathetically, discussing relevant tests and lifestyle factors.
Develops an evidence-based management plan, balancing investigations, lifestyle changes, and reassurance.
Ensures appropriate follow-up, with safety-netting and a clear review timeline.

PITFALLS

Failing to explore red flags, such as unintentional weight loss, night sweats, or cardiac symptoms.
Over-reassuring without investigation, leading to missed underlying conditions.
Over-investigating without clinical justification, causing unnecessary patient anxiety and costs.
Ignoring lifestyle contributions, such as alcohol intake, poor diet, and stress levels.
Failing to provide a follow-up plan, leaving the patient uncertain about next steps.

REFERENCES

MARKING

Each competency area is assessed on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Communication is appropriate to the patient’s concerns and sociocultural context.
1.2 Engages the patient to gather information about symptoms, concerns, and expectations.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Elicits a comprehensive history, including red flags and lifestyle factors.
2.2 Orders appropriate investigations, avoiding over-testing.

3. Diagnosis, Decision-Making and Reasoning

3.1 Develops a structured differential diagnosis for non-specific symptoms.
3.2 Identifies indications for further investigation or referral.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops a safe and evidence-based management plan, including investigations and lifestyle interventions.
4.2 Provides pharmacological and non-pharmacological treatment options, ensuring a patient-centred approach.

5. Preventive and Population Health

5.1 Discusses lifestyle changes and screening relevant to the presentation.

6. Professionalism

6.1 Maintains confidentiality and ethical decision-making.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures accurate documentation and appropriate follow-up.

9. Managing Uncertainty

9.1 Provides reassurance and safety-netting, ensuring the patient understands when to seek urgent care.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises vague symptoms that may indicate an underlying serious condition.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD