Case Information
- Case ID: TR-009
- Patient Name: David Collins
- Age: 56
- Gender: Male
- Indigenous Status: Non-Indigenous
- Year: 2025
- ICPC-2 Codes: A91 – Abnormal Test Results, K86 – Hypertension
Competency Outcomes
| Competency Domain | Competency Element |
|---|---|
| 1. Communication and Consultation Skills | Discussing abnormal test results with the patient in a clear, empathetic, and structured manner |
| 2. Clinical Information Gathering and Interpretation | Interpreting abnormal blood test results in the context of the patient’s risk factors |
| 3. Diagnosis, Decision-Making and Reasoning | Evaluating the clinical significance of abnormal results and determining further management |
| 4. Clinical Management and Therapeutic Reasoning | Implementing evidence-based management for cardiovascular risk factors |
| 5. Preventive and Population Health | Addressing lifestyle modifications and risk factor reduction |
| 6. Professionalism | Ensuring patient-centred communication and shared decision-making |
| 7. General Practice Systems and Regulatory Requirements | Ordering appropriate follow-up investigations and referrals |
| 9. Managing Uncertainty | Recognising when further investigations or specialist input is required |
| 10. Identifying and Managing the Patient with Significant Illness | Identifying potential cardiovascular disease and preventing complications |
Case Features
- 56-year-old male presents for follow-up after a routine health check-up.
- Asymptomatic, but has a family history of cardiovascular disease.
- Recent blood test results:
- Total cholesterol: 6.5 mmol/L (high)
- LDL cholesterol: 4.2 mmol/L (high)
- HDL cholesterol: 1.0 mmol/L (low)
- Triglycerides: 2.8 mmol/L (high)
- Fasting glucose: 6.3 mmol/L (borderline elevated)
- BP: 145/90 mmHg (elevated)
- No previous history of diabetes, hypertension, or hyperlipidaemia.
Instructions
The candidate is expected to review the following patient record and scenario. The examiner will ask a series of questions based on this information. The candidate has 15 minutes to complete this case.
The approximate time allocation for each question:
- Question 1: 3 minutes
- Question 2: 3 minutes
- Question 3: 3 minutes
- Question 4: 3 minutes
- Question 5: 3 minutes
Patient Record Summary
Patient Details
- Name: David Collins
- Age: 56
- Gender: Male
- Indigenous Status: Non-Indigenous
Allergies and Adverse Reactions
- No known drug allergies
Medications
- Nil regular medications
Past History
- No previous diagnosis of hypertension, diabetes, or hyperlipidaemia
Social History
- Works as an accountant, sedentary lifestyle
- Smokes 10 cigarettes/day for 20 years
- Drinks alcohol socially (3-4 standard drinks on weekends)
- Diet high in processed foods, low in vegetables
- No regular exercise
Family History
- Father had a myocardial infarction at 60
- Mother had type 2 diabetes
Vaccination and Preventive Activities
- Influenza vaccine: Up to date
- COVID-19 booster: Received
Scenario
David Collins, a 56-year-old accountant, attends for follow-up of routine blood tests.
He is asymptomatic but has a strong family history of cardiovascular disease.
His recent test results show:
- Elevated total cholesterol, LDL, and triglycerides
- Low HDL cholesterol
- Borderline fasting glucose
- Elevated blood pressure
David does not take any medications and has never been diagnosed with cardiovascular disease, hypertension, or diabetes. He is concerned about his heart health and wants to know if he needs treatment.
On examination:
- BP: 145/90 mmHg
- BMI: 29 kg/m² (overweight)
- No peripheral oedema or carotid bruits
- Heart sounds normal, no murmurs
Examiner Only Information
Questions
Q1. How would you explain these abnormal test results to David in a way he can understand?
- Prompt: How do you communicate results clearly and non-alarmingly?
- Prompt: How do you engage him in shared decision-making?
Q2. What is the significance of these findings in relation to his cardiovascular risk?
- Prompt: How do these results impact his cardiovascular risk assessment?
- Prompt: When would you consider initiating pharmacological therapy?
Q3. What lifestyle modifications would you recommend to David?
- Prompt: What dietary and exercise changes can help manage his risk factors?
- Prompt: How would you address smoking cessation and alcohol use?
Q4. When would you consider starting medications for his condition?
- Prompt: What are the indications for statins, antihypertensives, or metformin?
- Prompt: How do you balance lifestyle interventions with medication initiation?
Q5. What follow-up plan would you establish for David?
- Prompt: What tests should be repeated, and when?
- Prompt: When should specialist referral be considered?
THE COMPETENT CANDIDATE
The competent candidate should be able to:
Q1. How would you explain these abnormal test results to David in a way he can understand?
The competent candidate should:
- Use clear, non-alarmist language to ensure David understands the significance of his results.
- Explain that cholesterol and blood pressure levels are higher than recommended, which increase his risk of heart disease and stroke over time.
- Frame the discussion positively, focusing on modifiable risk factors and strategies to improve his health.
- Use visual aids or absolute risk scores, such as the Australian Cardiovascular Risk Calculator, to demonstrate his risk of a heart attack or stroke.
- Address David’s concerns and expectations, ensuring he feels involved in the decision-making process.
- Avoid over-medicalising the discussion—emphasise lifestyle changes as the first-line approach.
- Encourage questions and confirm understanding by asking David to summarise the key points.
SUMMARY OF A COMPETENT ANSWER
- Uses clear, non-technical language to explain abnormal results.
- Frames the discussion around cardiovascular risk and modifiable factors.
- Involves the patient in shared decision-making, ensuring concerns are addressed.
- Uses absolute risk tools to personalise risk assessment.
- Encourages lifestyle changes before considering medication.
PITFALLS
- Using overly medical jargon, which may confuse or distress the patient.
- Failing to personalise risk and focusing only on individual results rather than overall health.
- Over-emphasising medication without discussing lifestyle modifications first.
- Not checking for patient understanding or addressing concerns.
REFERENCES
- RACGP Guidelines for Cardiovascular Risk Management
- Australian Heart Foundation on Managing High Cholesterol
- NPS MedicineWise on Understanding Cardiovascular Risk Scores
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 Communicates in a patient-centred, culturally appropriate manner.
1.3 Engages the patient to discuss concerns and expectations about test results.
2. Clinical Information Gathering and Interpretation
2.1 Interprets test results in the context of the patient’s cardiovascular risk factors.
2.3 Uses appropriate risk assessment tools to guide discussions.
3. Diagnosis, Decision-Making and Reasoning
3.1 Identifies key clinical concerns and determines appropriate next steps.
3.5 Uses clinical reasoning to decide on further investigations or treatment options.
Competency at Fellowship Level
☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD