CASE INFORMATION

Case ID: CCE-CE-011
Case Name: Emily Dawson
Age: 34
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: P77 (Domestic Violence), P76 (Depressive Disorder), A04 (Weakness/Tiredness General), X76 (Anxiety Disorder)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages the patient to understand their concerns and expectations 1.2 Uses active listening and empathy to explore the patient’s illness experience 1.5 Provides clear and sensitive explanations of support options and safety planning
2. Clinical Information Gathering and Interpretation	2.1 Takes a sensitive and thorough history to assess risk and impact of domestic violence 2.2 Identifies red flags for immediate danger or escalation 2.3 Assesses the physical, psychological, and social consequences of domestic violence
3. Diagnosis, Decision-Making and Reasoning	3.1 Recognises clinical features suggestive of domestic violence and psychological distress 3.3 Considers and rules out alternative explanations for symptoms
4. Clinical Management and Therapeutic Reasoning	4.2 Provides appropriate referrals, support, and crisis intervention 4.4 Ensures a safe and patient-centred management plan
5. Preventive and Population Health	5.2 Provides education on support services, legal options, and safety planning
6. Professionalism	6.2 Demonstrates sensitivity and confidentiality when discussing domestic violence
7. General Practice Systems and Regulatory Requirements	7.1 Ensures compliance with mandatory reporting obligations where required
9. Managing Uncertainty	9.1 Addresses patient concerns about leaving the relationship, financial dependence, and stigma
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises and initiates management for trauma, depression, and anxiety related to domestic violence

CASE FEATURES

Appears anxious and avoids eye contact when discussing home life.
34-year-old woman presenting with fatigue, anxiety, and vague somatic complaints.
Recent unexplained weight loss and difficulties sleeping.
Frequent GP visits for non-specific pain and headaches.
Husband controls finances, isolates her from family, and belittles her.
She is fearful but hesitant to disclose domestic violence due to financial dependence and concern for her children.

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

Emily Dawson, a 34-year-old stay-at-home mother of two, presents to your general practice with fatigue, anxiety, and trouble sleeping. She has been losing weight without trying and feels constantly on edge.

She has been visiting the GP frequently for vague physical symptoms, including headaches, muscle aches, and digestive issues, but no medical cause has been identified.

PATIENT RECORD SUMMARY

Patient Details

Name: Emily Dawson
Age: 34
Gender: Female
Gender Assigned at Birth: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Nil regular medications

Past History

No significant medical history

Social History

Stay-at-home mother to two children (ages 5 and 7).
No history of alcohol or drug use.

Family History

No known mental health or chronic illnesses in the family.

Vaccination and Preventative Activities

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 exhausted and anxious all the time. I can’t sleep properly, and I keep losing weight. I don’t know what’s wrong.”

General Information

(Can be shared freely if the candidate asks open-ended questions like “Tell me more about that.”)

You feel tired all the time and struggle to get through the day.
You have trouble sleeping, often waking up feeling restless and on edge.
You have lost weight without trying and often don’t feel hungry.
You get frequent headaches, muscle aches, and digestive issues, but there doesn’t seem to be a clear reason.
You feel anxious and on edge at home, but you can’t quite explain why.
You have been seeing the doctor more often recently for vague physical symptoms, but tests haven’t found anything wrong.

Specific Information

(Only Reveal When Asked Directly and with Sensitivity)

Home Life and Relationship

You are married with two children (ages 5 and 7) and a stay-at-home mother.
Your husband works full-time and controls the finances—you don’t have your own bank account.
He doesn’t like you seeing friends or family and gets angry if you talk to them too much.
He checks your phone and asks who you’ve been talking to.
You feel like you always have to be careful what you say to avoid making him angry.
He often criticises you, calling you stupid, lazy, and useless.
You have started to believe that maybe you really aren’t good enough.

Safety and Risk Assessment

You haven’t been physically hit, but your husband has thrown things, punched walls near you, and screamed in your face.
He hasn’t threatened to kill you, but he has said you would be nothing without him.
He has threatened to take the children away if you ever tried to leave.
You don’t think he would actually hurt you, but you feel scared when he is angry.
The children haven’t seen the worst of it, but they sometimes hide in their rooms when he shouts.

Emotional and Psychological State

You feel trapped and don’t know what to do.
You have been crying more often, sometimes over small things.
You feel numb and disconnected from things you used to enjoy.
You don’t tell your husband when you come to the doctor—you say it’s for the kids instead.
You are afraid of making things worse if you talk about it.

Concerns and Questions for the Candidate

(Ask these naturally during the consultation, especially when discussing diagnosis or management.)

“Is this just normal stress, or could there be something really wrong with me?”
“I don’t want to ruin my family—should I just try harder to keep the peace?”
“If I tell you everything, will you have to report it?”
“Where would I go if I left? I don’t have any money.”
“Could this be affecting my kids? They don’t see anything, but they hear the arguments.”
“What if he finds out I’m talking to you about this? Won’t that make things worse?”
“Am I overreacting? He says I’m being dramatic.”

Role-Playing Emotional Cues

(Act these out realistically to simulate a real patient encounter.)

Fear: Speak softly, hesitate, and avoid eye contact when discussing your husband.
Anxiety: Fidget with your hands, keep checking your phone, and glance towards the door.
Sadness: Tear up when talking about your children or feeling trapped.
Confusion: Ask if what you’re experiencing is normal or if you’re overreacting.
Hopelessness: Shrug or sigh when discussing options, as if you don’t believe there is a way out.
Relief (if reassured well): Sit up straighter, make more eye contact, and engage more in the conversation.

What You Are Expecting From the Doctor (Candidate)

To listen without judgment.
To acknowledge your fear and validate that this is not normal or your fault.
To explain your options clearly, without pressure.
To ensure confidentiality but explain mandatory reporting laws.
To provide practical help—referrals, safety planning, and support contacts.
To not push you to leave immediately—you need to feel safe and supported, not rushed.

Potential Curveballs

(Optional, if the Candidate Handles the Basics Well)

“Would he get in trouble if I told someone? I don’t want to make him angry.”
“Could this be postpartum depression? I felt a bit like this after my second child.”
“What if I don’t want to leave? Can I just make things better at home?”
“My friend had an AVO against her partner, but it didn’t stop him from harassing her. Does that even work?”
“I’ve heard refuges are horrible. Are they safe for kids?”

End of Consultation

(If the candidate provides a clear plan and reassurance, respond positively.)

“Okay, that makes sense. I just want to feel safe and not so exhausted all the time. I’ll think about what you’ve said and maybe try reaching out for help.”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, exploring the patient’s symptoms and risk factors sensitively.

The competent candidate should:

Use open-ended, non-judgmental questions to explore fatigue, anxiety, sleep disturbance, weight loss, and frequent GP visits.
Establish the timeline and progression of symptoms.
Assess home life and relationships, using validated screening tools for domestic violence (e.g., HITS, SAFE, or LIVES model).
Ask about financial control, emotional and psychological abuse, coercion, and social isolation.
Determine any immediate risk of harm, including:
- Physical abuse or threats.
- Control over the patient’s movement, access to care, and finances.
- Children witnessing violence or being at risk.
Assess mental health symptoms, including:
- Depression, anxiety, PTSD symptoms, and suicidal ideation.
Evaluate barriers to leaving, including financial dependence, social isolation, and fears of escalation.

Task 2: Identify and outline red flags that indicate risk of immediate harm or escalation.

The competent candidate should:

Signs of escalating violence, including:
- Physical violence (recent injuries, bruises, avoidance of physical exam).
- Partner’s access to weapons, history of prior violence, or substance abuse.
- Threats to kill, self-harm, or harm children.
Severe psychological impact, including:
- Depression, suicidal thoughts, or PTSD symptoms.
Concerns for children’s safety, which may trigger mandatory reporting under child protection laws.
Isolation and financial control, reducing the patient’s ability to seek help.

Task 3: Provide a safe and structured management plan, including referrals, support options, and follow-up.

The competent candidate should:

Ensure immediate safety:
- Ask if the patient feels safe at home.
- Create a safety plan if needed (e.g., emergency contact, escape plan).
Offer support services:
- 1800 RESPECT (national domestic violence helpline).
- Local women’s shelters and social workers.
- Legal aid for protective orders and financial support.
Address mental health concerns:
- Referral to counselling, trauma-focused therapy, or GP mental health care plan.
- Consider short-term pharmacological support if clinically indicated.
Arrange follow-up:
- Regular check-ins for support and monitoring.
- Ensure a private and safe environment for future discussions.

Task 4: Address the patient’s concerns about leaving the relationship, financial stability, and confidentiality.

The competent candidate should:

Validate concerns and provide reassurance:
- Acknowledge the difficulty of the situation without judgment.
- Reassure that support is available, regardless of whether she stays or leaves.
Discuss financial and housing options:
- Explain Centrelink emergency payments and crisis accommodation services.
- Provide referral to a financial counsellor or legal aid.
Clarify confidentiality and mandatory reporting:
- Explain GP confidentiality rules but highlight exceptions for child protection concerns.
Provide ongoing support:
- Encourage a gradual approach to planning for safety rather than sudden decisions.
- Ensure continuity of care and a trusted contact point for support.

SUMMARY OF A COMPETENT ANSWER

Thorough and sensitive history-taking, exploring psychological, social, and physical aspects of domestic violence.
Identification of red flags, ensuring assessment of immediate safety and risk factors.
Development of a comprehensive safety plan, including referrals to domestic violence services, financial support, and counselling.
Empathetic communication, validating the patient’s experience and reducing feelings of isolation.
Clear follow-up strategy, ensuring continued support and monitoring for escalation or new risks.

PITFALLS

Failing to explore domestic violence sensitively, leading to missed diagnosis or reluctance to disclose.
Providing premature advice to leave, without addressing safety planning and financial barriers.
Neglecting to assess children’s safety, which may delay mandatory reporting and intervention.
Overlooking mental health concerns, such as PTSD, depression, or anxiety disorders.
Not scheduling follow-up, resulting in loss of contact and potential worsening of risk.

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 on their lives.
1.5 Provides clear and sensitive explanations of support options and safety planning.

2. Clinical Information Gathering and Interpretation

2.1 Takes a sensitive and thorough history to assess risk and impact of domestic violence.
2.2 Identifies red flags for immediate danger or escalation.
2.3 Assesses the physical, psychological, and social consequences of domestic violence.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises clinical features suggestive of domestic violence and psychological distress.
3.3 Considers and rules out alternative explanations for symptoms.

4. Clinical Management and Therapeutic Reasoning

4.2 Provides appropriate referrals, support, and crisis intervention.
4.4 Ensures a safe and patient-centred management plan.

5. Preventive and Population Health

5.2 Provides education on support services, legal options, and safety planning.

6. Professionalism

6.2 Demonstrates sensitivity and confidentiality when discussing domestic violence.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures compliance with mandatory reporting obligations where required.

9. Managing Uncertainty

9.1 Addresses patient concerns about leaving the relationship, financial dependence, and stigma.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises and initiates management for trauma, depression, and anxiety related to domestic violence.

Competency at Fellowship Level

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