CASE INFORMATION

Case ID: AP-002
Case Name: Michael Johnson
Age: 45 years
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2024
ICPC-2 Codes: A98 (Administrative procedure NOS)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages effectively with the patient to clarify their administrative needs. 1.2 Communicates clearly about medical documentation requirements. 1.3 Ensures patient understanding of the process and any legal or ethical considerations.
2. Clinical Information Gathering and Interpretation	2.1 Clarifies the reason for the administrative request and assesses its validity. 2.2 Identifies any underlying medical or psychosocial concerns related to the request.
3. Diagnosis, Decision-Making and Reasoning	3.1 Evaluates whether the requested administrative document is appropriate and aligns with medical guidelines. 3.2 Identifies any potential legal, professional, or ethical considerations in fulfilling the request.
4. Clinical Management and Therapeutic Reasoning	4.1 Develops an appropriate plan to provide the necessary documentation or alternative solutions. 4.2 Advises the patient on follow-up steps or additional requirements.
5. Preventive and Population Health	5.1 Identifies opportunities for health promotion or preventive care within the consultation.
6. Professionalism	6.1 Maintains professional boundaries while handling patient requests. 6.2 Ensures confidentiality and adherence to legal requirements.
7. General Practice Systems and Regulatory Requirements	7.1 Demonstrates knowledge of administrative documentation requirements, including workplace, insurance, and Centrelink forms. 7.2 Ensures documentation meets legal and regulatory standards.
9. Managing Uncertainty	9.1 Explains the limitations of GP-issued documents and advises on alternative pathways if required.

CASE FEATURES

A 45-year-old male presents requesting a medical certificate for extended sick leave.
His request raises concerns about potential workplace issues or underlying mental health concerns.
The GP must assess the legitimacy of the request while maintaining professional integrity.
The case explores balancing patient advocacy with ethical documentation.
Discussion of alternative options if a medical certificate cannot be provided.

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

Michael Johnson, a 45-year-old office worker, presents to your clinic requesting a medical certificate for an additional four weeks of sick leave. He states that his employer requires a doctor’s note to justify his absence due to work-related stress. Michael had previously taken two weeks of sick leave but now feels he is not ready to return to work. He reports difficulty sleeping, increased anxiety, and low motivation but has not seen a psychologist.

PATIENT RECORD SUMMARY

Patient Details

Name: Michael Johnson
Age: 45 years
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Nil current

Past History

No significant medical history

Social History

Works as an administrative officer in a corporate office
No smoking or drug use
Drinks 1-2 standard drinks per night

Family History

No known psychiatric illnesses
Father had hypertension and type 2 diabetes

Vaccination and Preventive Activities

Up to date

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

“Hi Doctor, I need a medical certificate for another four weeks off work. My employer says I can’t extend my sick leave without one.”

General Information

Your name is Michael Johnson, and you are a 45-year-old administrative officer who has been working in the same company for the past 10 years. You live with your wife and two teenage children. You are here today because your workplace is demanding a medical certificate if you want to extend your sick leave by another four weeks.

Specific Information

(Only Provide if Asked Relevant Questions)

Background Information

You initially took two weeks off work due to stress and exhaustion, but now that time has run out, and you don’t feel ready to return. You feel like your boss is pushing you to return too soon, and you are afraid that if you don’t get a certificate, you will be forced back to work before you are ready.

You haven’t seen a psychologist or taken medication, and you don’t think you need either. You just feel like you need more time to rest and regain your energy. You don’t think talking to someone about work stress will help because you already know what’s causing the problem. You just want some time off to get back on track.

Symptoms and Wellbeing

You haven’t been sleeping well, waking up multiple times during the night and feeling tired during the day.
You feel irritable and overwhelmed, and sometimes you struggle to focus on simple tasks.
You have no history of anxiety or depression, but lately, you feel like everything is too much.
You feel mentally exhausted, and you think more time off will help.
You don’t have thoughts of self-harm or suicide, but you feel like you just want to shut everything out for a while.
You don’t have any significant physical health issues.

Work Situation

You have been at your company for 10 years and generally like your job, but lately, you feel like the stress is unbearable.
You took two weeks of sick leave but still don’t feel ready to go back.
Your boss is demanding a medical certificate to approve another four weeks.
You feel like HR is not supportive, and you don’t trust them to handle this fairly.
You are worried about losing your job but also feel incapable of coping with work right now.

Concerns and Expectations

You expect the doctor to issue a certificate for four weeks because your employer won’t accept anything else.
You don’t want to see a psychologist or be told to take medication—you just want time off.
You feel frustrated if the doctor questions your need for leave because you believe you know what’s best for your health.
If the doctor refuses to give you the certificate, you might become frustrated or defensive, but you are still willing to discuss other options if they seem reasonable.
You don’t want to go on Centrelink, but you might ask if that’s an option if you don’t get the time off you need.

Emotional Cues and Behaviour

At first, you are calm but firm in your request.
If the doctor expresses hesitation, you become slightly defensive and might say:
- “I don’t understand why this is a problem. I just need time to get myself together.”
If the doctor questions whether you really need four weeks, you may feel frustrated and say:
- “I know myself. I need this time, and my employer won’t let me have it without this certificate.”
If the doctor suggests a mental health plan or counselling, you sigh and shake your head, responding:
- “I don’t need a psychologist. I just need some space.”
If the doctor explains why they can’t give the certificate, you might look worried and stressed, saying:
- “So what am I supposed to do? My boss won’t let me take leave without it.”
If the doctor proposes alternative solutions, like a shorter certificate, a staged return to work, or support services, you listen carefully but still express hesitation.

Questions for the Candidate

You should naturally ask these questions during the consultation:

“Can you just write the certificate? I really need this time off.”
“Do I have to see a psychologist for you to approve this?”
“What happens if my employer doesn’t accept anything less than four weeks?”
“If I don’t get paid leave, can I get Centrelink support?”
“What else can I do if you can’t give me the certificate?”

Possible Responses to the Doctor’s Suggestions

If the Doctor Approves the Certificate for Four Weeks:

You nod with relief and say: “Thanks, that’s what I needed.”
You appreciate their support but don’t ask further questions.

If the Doctor Offers a Shorter Certificate Instead:

You look frustrated and concerned, saying:
- “That won’t work. My boss says it has to be four weeks.”
If the doctor explains why they can’t justify four weeks, you listen but remain uneasy.

If the Doctor Suggests Counselling or a Mental Health Plan:

You sigh and shake your head, responding:
- “I don’t need that. I just need rest.”
If they insist on an assessment, you may say:
- “Fine, I’ll think about it, but I just need time off first.”

If the Doctor Refuses to Provide the Certificate:

You look stressed and frustrated, saying:
- “So what do I do now? I can’t just go back like this.”
If the doctor offers alternative options, you reluctantly listen but may still push for time off.

Final Behavior and Conclusion

If the doctor explains things well and gives alternative options, you gradually become more open to discussion.
If they firmly refuse without offering solutions, you may appear upset but not aggressive.
You leave saying either:
- “Alright, I guess I’ll figure something out.” (if disappointed)
- “Thanks, I’ll consider what you’ve said.” (if you feel supported)

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a focused history from the patient regarding his medical certificate request, including any medical or psychosocial concerns.

The competent candidate should:

Use open-ended questions to explore the patient’s request for a medical certificate, ensuring clarity on the reason for the extension.
Ask about specific symptoms of stress or mental health concerns, including sleep disturbances, mood changes, concentration difficulties, or anxiety symptoms.
Assess functionality, including whether the patient is engaging in daily activities, social interactions, and family responsibilities.
Clarify workplace dynamics, including any conflicts, job security concerns, or perceived pressure from the employer.
Explore previous coping mechanisms, such as past experiences with stress, mental health support, or strategies used to manage work-related difficulties.
Take a social history, assessing family and financial stressors, and whether the patient has support at home.
Assess for red flags, such as self-harm, suicidal ideation, or substance use, and address appropriately if present.
Summarise key findings to confirm understanding and engage the patient in a collaborative discussion about next steps.

Task 2: Explain your assessment of the request and any necessary limitations or ethical considerations.

The competent candidate should:

Acknowledge the patient’s concerns and difficulties with returning to work.
Explain that medical certificates should reflect an evidence-based assessment and that documentation must be ethically and professionally justified.
Outline that sick leave is granted for a medical condition, and without a formal mental health diagnosis or significant impairment, an extended certificate may not be justified.
Explain the importance of further assessment, potentially including a mental health care plan or psychological support, to determine the best course of action.
Discuss the employer’s role and responsibilities, including workplace adjustments and support services available.
Offer alternative solutions, such as:
- A shorter sick leave period with a review in one to two weeks.
- A graduated return-to-work plan, which may be more acceptable to the employer.
- Referral for workplace mediation or HR discussions to address stressors.
Reassure the patient that their concerns are valid and work with them to create a safe, ethical, and practical plan.

Task 3: Provide a safe and professional management plan, ensuring compliance with documentation requirements.

The competent candidate should:

Ensure any documentation is accurate, justified, and compliant with Australian medical and legal standards.
If a certificate is appropriate, specify:
- The recommended duration of leave.
- Medical justification, while maintaining confidentiality.
- A planned review date to assess the patient’s progress.
If a four-week certificate cannot be provided, offer a compromise, such as a one to two-week certificate with follow-up.
Encourage further support, including a mental health care plan and referral to a psychologist or counsellor.
Discuss self-care strategies to improve resilience, such as exercise, sleep hygiene, mindfulness, and social support.
Provide education on Centrelink options, including sickness allowance or employee rights under workplace laws.
Ensure the patient understands the plan and schedule a follow-up appointment to reassess symptoms and work status.

Task 4: Address the patient’s concerns, provide guidance on follow-up steps, and ensure patient understanding.

The competent candidate should:

Acknowledge and validate the patient’s distress about returning to work.
Reassure that work-related stress is common, and there are strategies and support services available.
Explain why a four-week certificate may not be medically justified while still offering practical alternatives.
Educate the patient about mental health support, including counselling, workplace adjustments, and lifestyle modifications.
Provide clear safety-netting advice, including when to seek urgent mental health support.
Encourage open communication with the employer, including seeking HR assistance or exploring workplace accommodations.
Offer a review appointment to reassess symptoms and modify the plan as needed.

SUMMARY OF A COMPETENT ANSWER

Demonstrates structured and empathetic history-taking, exploring both medical and psychosocial factors.
Acknowledges workplace stress while ensuring the certificate request is ethically justified.
Explains professional limitations in medical documentation while offering alternative solutions.
Provides a well-structured management plan, incorporating mental health support, workplace adjustments, and follow-up.
Ensures patient understanding through clear communication, reassurance, and a collaborative approach.

PITFALLS

Automatically providing a four-week certificate without a clinical basis, compromising professional integrity.
Failing to explore underlying mental health concerns, missing potential risks like anxiety, depression, or workplace bullying.
Dismissing the patient’s concerns too quickly, leading to frustration and disengagement.
Not considering alternative options, such as a graduated return-to-work plan or HR involvement.
Neglecting to provide follow-up or safety-netting, leaving the patient unsupported.

REFERENCES

MARKING

Each competency area is assessed on the following scale:

☐ 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 sociocultural context
1.2 Engages the patient to gather information about symptoms, concerns, and expectations
1.3 Addresses patient concerns empathetically and provides reassurance

2. Clinical Information Gathering and Interpretation

2.1 Clarifies the reason for the administrative request and assesses its validity
2.2 Identifies any underlying medical or psychosocial concerns related to the request

3. Diagnosis, Decision-Making and Reasoning

3.1 Evaluates whether the requested administrative document is appropriate and aligns with medical guidelines
3.2 Identifies potential legal, professional, or ethical considerations in fulfilling the request

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an appropriate plan to provide the necessary documentation or alternative solutions
4.2 Advises the patient on follow-up steps or additional requirements

5. Preventive and Population Health

5.1 Identifies opportunities for health promotion or preventive care within the consultation

6. Professionalism

6.1 Maintains professional boundaries while handling patient requests
6.2 Ensures confidentiality and adherence to legal requirements

7. General Practice Systems and Regulatory Requirements

7.1 Demonstrates knowledge of administrative documentation requirements, including workplace, insurance, and Centrelink forms
7.2 Ensures documentation meets legal and regulatory standards

9. Managing Uncertainty

9.1 Explains the limitations of GP-issued documents and advises on alternative pathways if required

Competency at Fellowship Level

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