CASE INFORMATION

Case ID: SP-003
Case Name: Sarah Thompson
Age: 38
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: Z29 (Social Problem NOS)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages the patient to understand their concerns and expectations 1.2 Explains management options clearly 1.5 Uses active listening and empathy
2. Clinical Information Gathering and Interpretation	2.1 Gathers a holistic history to assess social determinants of health 2.2 Identifies key psychosocial stressors contributing to the patient’s presentation
3. Diagnosis, Decision-Making and Reasoning	3.1 Identifies and prioritises key social issues impacting the patient’s well-being 3.2 Recognises the impact of social stressors on physical and mental health
4. Clinical Management and Therapeutic Reasoning	4.2 Develops a management plan including social and psychological support 4.3 Provides referral options for financial, housing, or social support services
5. Preventive and Population Health	5.1 Identifies and addresses broader social determinants of health 5.3 Provides advice on stress management and coping strategies
6. Professionalism	6.2 Maintains patient confidentiality and demonstrates a non-judgmental approach
7. General Practice Systems and Regulatory Requirements	7.3 Provides appropriate documentation and ensures follow-up
9. Managing Uncertainty	9.1 Recognises when further specialist or community support is required
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies red flags for significant social distress requiring urgent intervention

CASE FEATURES

A 38-year-old woman presenting with vague physical complaints and increased stress.
Signs of financial and emotional distress, impacting her mental and physical health.
Concerns about job loss, unstable housing, and parenting stress.
Patient may not initially disclose social problems unless prompted with open-ended questions.
Need for a patient-centred approach to explore and address underlying social concerns.
Referral pathways for social support, counselling, and financial assistance.
Risk assessment for family violence, self-harm, and mental health deterioration.

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 a physical 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

Sarah Thompson, a 38-year-old single mother, presents to your general practice complaining of poor sleep, headaches, and fatigue over the past two months. She initially describes her symptoms as stress-related but is hesitant to elaborate further.

PATIENT RECORD SUMMARY

Patient Details

Name: Sarah Thompson
Age: 38
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

None currently

Past History

No history of depression, anxiety, or chronic illnesses

Social History

Single mother of two children (aged 7 and 10)

Family History

No history of mental illness or significant medical conditions

Smoking & Alcohol

Non-smoker, no alcohol or drug use

Vaccination and Preventive Activities

Up to date with vaccinations

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 just been feeling so exhausted lately. I keep getting headaches, I’m not sleeping well, and I just feel run down all the time.”

General Information

(Freely Shared if Asked Open-Ended Questions)

Symptoms began two months ago, gradually worsening.
Main issues: poor sleep, frequent headaches, fatigue, low appetite, and stress.
No chronic illnesses, prior mental health diagnoses, or significant medical history.
Denies substance use, including alcohol and smoking.

Specific Information

(Only If Asked Targeted Questions)

Background Information

Financial stress and upcoming housing insecurity are major concerns.
Worried about her children’s well-being but does not want to burden them with her problems.
No immediate family support nearby; her parents live interstate and are not involved.
Lost her job recently, applying for Centrelink but worried about delays.
Considering a payday loan to cover rent but concerned about the long-term financial impact.

Social & Financial Stressors

Lost her job two months ago; was working in retail.
Has some savings but running out quickly.
Rental lease ends next month, and she has not found alternative accommodation.
Worried about homelessness but does not want to go to a shelter.
Has applied for Centrelink but has no approval yet.
Considering a payday loan but afraid of falling deeper into debt.

Parenting & Family Situation

Single mother of two children, aged 7 and 10.
Trying to shield them from financial difficulties, but they have noticed changes (e.g., eating out less, no more weekend outings).
Guilt over not being able to provide more for them.
No contact with children’s father; no child support.
No nearby family to help; parents live interstate and are not financially supportive.

Coping Strategies & Emotional Well-being

Has never sought psychological support before.
Feels embarrassed about needing help but wants guidance.
Used to go for walks and read to relax, but lately has no energy or motivation.
Worried about the long-term impact of stress on her health.
Denies suicidal thoughts but sometimes feels like she wants to escape from everything.
Does not want Child Services involved, afraid they might think she’s unfit to parent.

Emotional Cues & Reactions

Initially reserved, reluctant to discuss personal issues.
Teary-eyed when discussing financial struggles and fears of homelessness.
Visibly distressed when talking about her children, feels she is failing them.
Feels guilty about seeking help, as if she should “handle things on her own.”
Becomes more engaged if the doctor listens with empathy and offers practical solutions.
Relief and gratitude if the doctor provides non-judgmental support and referrals.

Questions the Patient Might Ask

“Is there any financial or housing help I can access?”
- (If the doctor is uncertain, she may appear frustrated or hopeless.)
“Am I overreacting, or is this something serious?”
- (If dismissed, she may shut down emotionally and disengage from the consultation.)
“Will this affect my kids? Should I be worried about Child Services?”
- (She becomes anxious if there is any mention of mandated reporting.)
“How can I manage stress when everything feels like it’s falling apart?”
- (If given only vague advice, she may feel unheard.)
“What can I do to feel better and cope with all this?”
- (She responds positively if offered practical steps and referrals.)

How to Play the Role

Opening Scene (First Few Minutes)

Appear tired, emotionally drained, and slightly hesitant.
Speak softly, avoiding eye contact initially.
Express frustration about feeling exhausted and not knowing what to do.

If the Doctor Asks About Social Stressors Early On:

Sigh and look away, as if debating whether to open up.
Gradually reveal financial concerns, but downplay their impact at first.
Show relief if the doctor listens empathetically.

If the Doctor Dismisses the Emotional or Social Components:

Shut down emotionally, provide short answers, and appear disengaged.
Change the topic back to physical symptoms (e.g., “I just want something for the headaches”).
Avoid discussing financial struggles further.

If the Doctor Provides Practical Support and Resources:

Appear relieved but also uncertain about next steps.
Ask specific questions about financial aid, housing support, and childcare assistance.
Show cautious optimism, asking how to get started with support services.

Ending the Consultation (Final Reaction Depending on the Doctor’s Approach)

If the Doctor Provides a Clear Plan and Reassurance:

Express gratitude, saying, “I didn’t know where to start, but this helps.”
Agree to follow up and contact support services.

If the Doctor Is Unclear or Dismissive:

Look disappointed and withdrawn.
Say, “I guess I’ll just figure it out on my own.”
Leave feeling unsupported and unlikely to follow up.

Key Features for the Examiner to Observe

How well the candidate identifies and explores social determinants of health.
Ability to establish rapport and create a safe space for disclosure.
Whether they provide practical support options, including referrals.
How they manage patient distress and concerns about Child Services involvement.
Ensuring safety netting and appropriate follow-up.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a holistic history to assess social, financial, and emotional stressors.

The competent candidate should:

Use open-ended questions to explore the patient’s physical, emotional, and social concerns.
Clarify physical symptoms: onset, duration, aggravating or relieving factors, and impact on daily functioning.
Explore emotional well-being, including mood changes, feelings of hopelessness, and coping mechanisms.
Assess financial and housing stability, including recent job loss, ability to meet rent or mortgage payments, and food security.
Identify support systems, including family, friends, or community resources.
Screen for risk factors, such as domestic violence, substance use, or neglect concerns regarding her children.
Summarise key issues and explore the patient’s expectations from the consultation.

Task 2: Identify key risk factors and red flags that may require urgent intervention.

The competent candidate should:

Recognise urgent social red flags, such as:
- Imminent homelessness or eviction.
- Food insecurity leading to malnutrition.
- Severe financial distress, considering payday loans.
Identify mental health concerns:
- Suicidal ideation or thoughts of self-harm.
- Signs of major depression (e.g., persistent sadness, loss of motivation, inability to care for children).
- Social withdrawal or complete lack of support.
Consider child safety concerns:
- Neglect due to financial hardship (e.g., lack of food, healthcare access).
- Fear of Child Services involvement – requires careful, non-judgmental exploration.
Ensure safety netting and urgent referrals if high-risk issues are identified.

Task 3: Address the patient’s concerns empathetically and discuss possible support options.

The competent candidate should:

Acknowledge and validate her distress, using empathetic language (e.g., “It sounds like you’re facing a lot right now. Let’s explore what support is available.”).
Reassure her that asking for help is not a failure but an essential step.
Address fears about Child Services in a non-threatening way, clarifying that support services exist to assist families, not punish them.
Provide realistic, practical guidance, such as:
- Local financial assistance programs (e.g., Centrelink crisis payments, rent relief schemes).
- Food banks and emergency relief services.
- Mental health support, such as free counselling through Better Access (Medicare-subsidised psychology) or local support groups.
Encourage small, achievable steps (e.g., making one phone call to a support service).

Task 4: Develop a patient-centred management plan, including appropriate referrals.

The competent candidate should:

Create a stepwise, achievable plan, ensuring clear follow-up.
Referral options include:
- Financial and housing support: Local housing assistance services, welfare agencies, financial counselling.
- Mental health support: GP Mental Health Plan (Better Access Initiative), Head to Health, crisis helplines (Beyond Blue, Lifeline).
- Social support: Community organisations, single-parent support groups.
Check patient engagement – encourage active participation in decision-making.
Provide safety netting:
- Schedule a follow-up within 1–2 weeks.
- Advise when to seek urgent care, such as worsening mental health or safety concerns for herself or her children.

SUMMARY OF A COMPETENT ANSWER

Holistic history-taking, addressing social determinants of health, emotional well-being, and financial struggles.
Identification of key risk factors and red flags, including mental health, housing insecurity, and child safety concerns.
Empathetic communication, ensuring the patient feels heard, supported, and not judged.
Clear explanation of available support services, including financial aid, food assistance, and mental health care.
Structured, patient-centred management plan, incorporating practical steps and appropriate referrals.
Appropriate safety netting and follow-up planning to ensure ongoing support.

PITFALLS

Failing to explore social issues thoroughly, focusing only on physical symptoms.
Ignoring financial distress, missing the impact of job loss and housing instability.
Providing premature reassurance without addressing real concerns about eviction and food insecurity.
Neglecting mental health assessment, particularly depressive symptoms or suicidal ideation.
Not addressing the patient’s fears about Child Services, leading to mistrust and disengagement.
Providing vague or impractical advice, rather than clear, actionable steps.
Lack of safety netting and follow-up, failing to check if the patient accesses support services.

REFERENCES

MARKING

Each competency area is 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 person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, expectations of healthcare, and the full impact of their illness experience.
1.5 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Gathers a holistic history to assess social determinants of health.
2.2 Identifies key psychosocial stressors contributing to the patient’s presentation.

3. Diagnosis, Decision-Making and Reasoning

3.1 Identifies and prioritises key social issues impacting the patient’s well-being.
3.2 Recognises the impact of social stressors on physical and mental health.

4. Clinical Management and Therapeutic Reasoning

4.2 Develops a management plan including social and psychological support.
4.3 Provides referral options for financial, housing, or social support services.

5. Preventive and Population Health

5.1 Identifies and addresses broader social determinants of health.
5.3 Provides advice on stress management and coping strategies.

6. Professionalism

6.2 Maintains patient confidentiality and demonstrates a non-judgmental approach.

7. General Practice Systems and Regulatory Requirements

7.3 Provides appropriate documentation and ensures follow-up.

9. Managing Uncertainty

9.1 Recognises when further specialist or community support is required.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies red flags for significant social distress requiring urgent intervention.

Competency at Fellowship Level

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