EXAMINER ONLY INFORMATION

QUESTIONS

Q1. What are your key differential diagnoses for Anna’s presentation?

• Prompt: What is the most likely diagnosis and why?
• Prompt: What other conditions should be considered?

Q2. What red flags would indicate the need for urgent referral or further intervention?

• Prompt: What features suggest serious psychological distress or risk?
• Prompt: What initial steps would you take if concerns about safety arise?

Q3. How would you manage Anna’s situation?

• Prompt: What practical and psychological interventions would you recommend?
• Prompt: What social support services might benefit her?

Q4. Anna is concerned about seeking help due to stigma and financial barriers. How would you counsel her?

• Prompt: How can you address concerns about confidentiality and stigma?
• Prompt: What financial and social support options are available?

Q5. What preventive strategies can Anna implement to improve her overall well-being?

• Prompt: How can she develop resilience and manage stress long-term?
• Prompt: What role do lifestyle changes and social connections play?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What are your key differential diagnoses for Anna’s presentation?

Anna’s most likely diagnosis is psychosocial distress related to financial stress and parenting demands, given her fatigue, difficulty sleeping, emotional exhaustion, and financial concerns.

Key Differential Diagnoses:

1. Psychosocial Distress (Most Likely) – Chronic stress affecting mood, energy, and concentration, often linked to financial hardship, social isolation, or caregiving burden.
2. Adjustment Disorder with Anxiety/Depressive Features – Emotional distress in response to a life stressor, such as job insecurity.
3. Generalised Anxiety Disorder (GAD) – Consider if persistent excessive worry, muscle tension, or panic symptoms.
4. Major Depressive Disorder (MDD) – If symptoms include low mood most days, anhedonia, significant sleep/appetite changes, and suicidal ideation.
5. Chronic Fatigue Syndrome or Sleep Disorder – If persistent unexplained fatigue not improved by rest.

Further assessment, including screening for depression, anxiety, and risk factors for mental illness, will refine the diagnosis.

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Q2: What red flags would indicate the need for urgent referral or further intervention?

Red flags requiring urgent intervention:

• Suicidal ideation or self-harm risk – Immediate mental health assessment needed.
• Severe functional impairment – Inability to work, care for children, or maintain daily tasks.
• Signs of domestic violence – Unexplained injuries, fearfulness, social withdrawal.
• Uncontrolled anxiety or panic attacks – Consider crisis support or medication initiation.
• Substance misuse as a coping mechanism – Risk of escalating dependence.

Initial Steps if Red Flags Present:

• Mental health risk assessment – Using K10 or PHQ-9.
• Immediate referral to crisis services – Lifeline (13 11 14), Beyond Blue, or mental health triage.
• Involve social services – If concerns about domestic violence, child welfare, or homelessness.

Anna has no immediate safety concerns, so supportive management and follow-up are appropriate.

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Q3: How would you manage Anna’s situation?

1. Immediate Support and Validation:

• Acknowledge her stress and validate concerns – “You’re facing a lot right now, and it’s understandable to feel overwhelmed.”
• Normalise seeking help – “Many people experience stress due to financial hardship, and support is available.”

2. Practical Interventions:

• Centrelink or financial counselling referral – Help with rent assistance, job security, or emergency relief.
• Community support programs – Parenting support groups, free legal advice.

3. Psychological Support:

• Refer for low-cost psychological services (Better Access Initiative, Head to Health).
• Self-help resources – Apps like Smiling Mind, Beyond Blue’s NewAccess.
• Mindfulness and relaxation techniques – Simple breathing exercises.

4. Medical Management (If Indicated):

• Trial of short-term SSRIs (e.g., sertraline 25–50mg daily) if anxiety is severe.
• Sleep hygiene strategies before considering pharmacological intervention.

5. Follow-Up:

• Review in 2–4 weeks to assess coping strategies and symptom changes.
• Escalate to mental health services if symptoms worsen.

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Q4: Anna is concerned about seeking help due to stigma and financial barriers. How would you counsel her?

1. Acknowledge Concerns & Provide Reassurance
   • “It’s understandable to worry about stigma, but seeking help is a sign of strength, not weakness.”
2. Explain Confidentiality
   • “Your information is confidential and not shared with employers or family without consent.”
3. Address Financial Barriers
   • “There are bulk-billed mental health plans and community services that offer free or low-cost support.”
4. Provide Practical Steps for Accessing Support
   • Centrelink financial assistance – Rent relief, JobSeeker eligibility.
   • Bulk-billed counselling (Better Access Initiative) – 10 free sessions with a mental health care plan.
5. Encourage Small, Manageable Steps
   • “Even one small change—like talking to a financial counsellor—can help ease the burden.”

Reducing stigma and financial concerns empowers the patient to seek necessary support.

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Q5: What preventive strategies can Anna implement to improve her overall well-being?

1. Self-Care & Resilience Building:
   • Set small, achievable goals to manage stress.
   • Prioritise sleep, regular meals, and physical activity.
2. Social & Community Engagement:
   • Encourage social connection – Parenting groups, local support networks.
   • Access community resources – Food banks, free childcare options.
3. Financial Planning Support:
   • Seek professional financial advice – MoneySmart, National Debt Helpline.
4. Early Intervention for Mental Health:
   • Regular GP check-ins to assess stress levels.
   • Use relaxation techniques (mindfulness, deep breathing exercises).
5. When to Seek Further Help:
   • If persistent low mood, panic attacks, or inability to cope with daily tasks, return for urgent mental health review.

Preventing further distress requires a combination of self-care, financial support, and access to community services.

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SUMMARY OF A COMPETENT ANSWER

• Comprehensive differential diagnosis, distinguishing psychosocial distress, adjustment disorder, and clinical anxiety or depression.
• Identification of red flags, ensuring escalation if needed.
• Structured, patient-centred management plan, including financial, psychological, and community support referrals.
• Clear, empathetic counselling, addressing stigma and access to affordable care.
• Preventive strategies, including stress management, resilience-building, and financial planning support.

PITFALLS

• Failing to assess for red flags, missing suicidal ideation or domestic violence.
• Overprescribing medications prematurely, without addressing underlying social issues.
• Not discussing financial assistance, leaving the patient without practical solutions.
• Lack of follow-up planning, leading to worsening distress or mental health decline.
• Minimising the patient’s concerns, rather than validating her experience and guiding support.

REFERENCES

• RACGP – RACGP Social Determinants of Health Guide
• Services Australia Centrelink Crisis Payments and Financial Assistance
• GP Exams – Social problem NOS

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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 Takes a sensitive and structured psychosocial history.
1.2 Provides clear, empathetic explanations and supports shared decision-making.

2. Clinical Information Gathering and Interpretation

2.1 Identifies social determinants affecting health and well-being.
2.2 Recognises when social issues contribute to physical and mental health symptoms.

3. Diagnosis, Decision-Making and Reasoning

3.1 Assesses the impact of social stressors on overall health.
3.2 Determines when multidisciplinary support or intervention is required.

Competency at Fellowship Level

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