CCE-CE-104

CASE INFORMATION

Case ID: CCE-2025-12
Case Name: James Carter
Age: 48
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: A34 (Blood test NOS)

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Establishes rapport and engages with the patient empathetically.
1.2 Uses clear, patient-centred language to explain blood test results.
1.4 Elicits the patient’s ideas, concerns, and expectations.
2. Clinical Information Gathering and Interpretation2.1 Takes a structured history, identifying risk factors relevant to abnormal blood results.
2.2 Interprets common abnormal blood test results in primary care.
2.3 Determines the need for further investigations or monitoring.
3. Diagnosis, Decision-Making and Reasoning3.1 Recognises potential causes of abnormal blood results.
3.3 Determines when urgent referral or repeat testing is required.
4. Clinical Management and Therapeutic Reasoning4.1 Develops an appropriate management plan based on blood test findings.
4.3 Provides lifestyle and preventive health advice.
4.5 Refers for specialist assessment if indicated.
5. Preventive and Population Health5.2 Discusses cardiovascular risk reduction and metabolic health.
6. Professionalism6.1 Ensures empathetic and professional communication regarding test results.
7. General Practice Systems and Regulatory Requirements7.2 Follows appropriate guidelines for pathology follow-up and recall.
9. Managing Uncertainty9.1 Recognises when abnormal results require further workup vs. reassurance.
10. Identifying and Managing the Patient with Significant Illness10.1 Identifies patients requiring urgent referral based on blood test findings.

CASE FEATURES

  • Middle-aged man presenting for review of abnormal blood test results.
  • Discussing the significance of results and next steps.
  • Balancing reassurance with appropriate investigation and management.
  • Addressing patient concerns about long-term health implications.
  • Providing preventive health advice and follow-up plans.

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:

  1. Take an appropriate history.
  2. Outline the differential diagnosis and key investigations required.
  3. Address the patient’s concerns.
  4. Develop a safe and patient-centred management plan.

SCENARIO

James Carter, a 48-year-old accountant, recently had a routine blood test as part of his workplace health check. He has come in today to review the results. His tests show:

  • Fasting blood glucose: 6.4 mmol/L (impaired fasting glucose)
  • Total cholesterol: 6.8 mmol/L (elevated)
  • LDL cholesterol: 4.2 mmol/L (elevated)
  • Triglycerides: 2.1 mmol/L (borderline high)
  • ALT: 48 U/L (mildly elevated, possible fatty liver)

PATIENT RECORD SUMMARY

Patient Details

Name: James Carter
Age: 48
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • Nil known

Medications

  • Nil regular medications

Past History

  • Borderline hypertension (monitored, not on treatment)
  • Overweight (BMI 29)

Family History

  • Father had a myocardial infarction at 52.
  • Mother has type 2 diabetes.

Smoking and Alcohol

  • Non-smoker.
  • Drinks alcohol 2–3 times per week (1–2 drinks per occasion).

Social History

  • Works full-time as an accountant, sedentary lifestyle.

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 got my blood test results back, and I’m a bit worried. Does this mean I have diabetes?”

General Information

You are James Carter, a 48-year-old accountant. You had a routine workplace health check last week, and now you’re here to go over the results.

You feel fine—no obvious symptoms of diabetes or heart disease—but seeing high cholesterol and blood sugar levels on your report has made you anxious.

Specific Information

(Revealed When Asked)

Background Information

You are particularly worried because your father had a heart attack at 52, and your mother has type 2 diabetes. You don’t want to end up with the same problems.

You haven’t had a full health check in years, but since you’re approaching 50, you thought it was a good idea. Now that you’ve seen the results, you’re wondering if you should have done this sooner.

Symptoms:

  • No excessive thirst or urination.
  • No unexplained weight loss or fatigue.
  • Occasionally feels tired after meals, but nothing concerning.

Diet and Lifestyle:

  • Sedentary job—you spend most of the day at a desk.
  • No structured exercise, but you do some weekend walking with your family.
  • Eats takeout for lunch most days—often sandwiches, pasta, or fast food.
  • Likes processed foods and sugary snacks, especially in the afternoon.
  • Drinks alcohol a few times a week (1–2 drinks per occasion).

Previous Health Checks:

  • Blood pressure has been borderline in the past but never treated.
  • Never been told he has high blood sugar before.
  • Cholesterol was slightly high a few years ago, but no action was taken.
  • Has never been on any regular medications.

Emotional Cues and Body Language

  • Slightly anxious but open to discussion.
  • Becomes more concerned if the doctor mentions ‘pre-diabetes’ or ‘high heart risk’.
  • Looks for reassurance but also wants a clear action plan.
  • Frowns if told he needs medication, but is willing to listen.
  • Sits forward attentively when the doctor explains next steps.

Patient Concerns and Questions

1. “Does this mean I have diabetes?”

  • You know your blood sugar is high, but you don’t fully understand what that means.
  • If the doctor says you have ‘pre-diabetes’, you will ask:
    • “So what does that mean? Will I definitely get diabetes?”

2. “Am I going to have a heart attack like my dad?”

  • You are concerned about your cholesterol and family history.
  • You will ask:
    • “How high is my risk?”
    • “Can I fix this with lifestyle changes, or do I need medication?”

3. “What do I need to do next?”

  • You expect clear guidance on what to change in your diet and lifestyle.
  • If the doctor only gives general advice, you might say:
    • “Can you be more specific? What foods should I eat or avoid?”

4. “Do I need medication?”

  • You prefer to try lifestyle changes first, but if medication is suggested, you will ask:
    • “How long would I need to take it for?”
    • “Are there any side effects?”

5. “Should I get more tests?”

  • You expect to repeat blood tests and might ask:
    • “When should I check this again?”
    • “Do I need any scans or heart tests?”

Possible Reactions Based on the Doctor’s Approach

If the doctor reassures you and explains pre-diabetes clearly:

  • You feel relieved and say:
    • “So I can prevent diabetes if I make some changes?”
  • You are motivated to improve your diet and exercise.

If the doctor is vague about risks or solutions:

  • You push for more details, asking:
    • “But what exactly should I do?”

If the doctor focuses only on medication without lifestyle advice:

  • You hesitate and say:
    • “I’d rather try diet and exercise first if that’s possible.”

If the doctor offers a structured plan with follow-up:

  • You feel encouraged and engaged, and you ask about how to track progress.

Your Expectations from This Consultation

  • You want a clear explanation of your risk for diabetes and heart disease.
  • You expect practical lifestyle advice that fits your busy schedule.
  • You want to know if medication is needed or if lifestyle changes are enough.
  • You want to know when to come back for follow-up tests.

End of Consultation Cues

  • If the doctor explains things clearly and provides a structured plan, you feel reassured and ready to make changes.
  • If the doctor brushes off your concerns, you push for more investigation.
  • If the doctor talks about heart risk and safety strategies, you feel more confident in their assessment.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Explain the blood test results to the patient, addressing his concerns.

The competent candidate should:

  • Acknowledge the patient’s concerns:
    • “I understand that seeing abnormal results can be worrying, and it’s great that you’ve come in to discuss them.”
  • Explain the key results in simple terms:
    • “Your fasting blood glucose is 6.4 mmol/L, which is in the pre-diabetes range.”
    • “Your cholesterol levels are elevated, with LDL at 4.2 mmol/L, which increases heart disease risk.”
    • “Your liver enzyme ALT is slightly raised, which may indicate fatty liver, likely related to your weight and cholesterol levels.”
  • Provide reassurance while setting a clear plan:
    • “These results mean we need to act now to reduce your long-term risk of diabetes and heart disease, but you don’t need medication just yet.”
  • Encourage patient engagement:
    • “What are your thoughts on these results? Is there anything specific you’re concerned about?”

Task 2: Discuss potential causes of the abnormal results, considering risk factors.

The competent candidate should:

  • Explain why these results are abnormal:
    • Pre-diabetes: Likely due to diet, sedentary lifestyle, and genetic factors (family history of diabetes).
    • High cholesterol: Likely from diet, genetic predisposition, and lack of exercise.
    • Mildly elevated ALT: Suggestive of fatty liver disease, often linked to diet and cholesterol levels.
  • Discuss the significance of family history:
    • “Your father had a heart attack at 52, which puts you at a higher risk. Addressing these factors now can help prevent future issues.”
  • Highlight modifiable risk factors:
    • “Your lifestyle plays a big role, so changes in diet, exercise, and weight management can significantly improve these results.”

Task 3: Develop a management plan, including lifestyle changes, follow-up tests, and possible referral.

The competent candidate should:

  • Short-term management:
    • “We will repeat your fasting glucose and HbA1c in 3 months to assess diabetes risk.”
    • “A liver ultrasound can check for fatty liver changes if needed.”
    • “Let’s also check your blood pressure regularly.”
  • Lifestyle modifications:
    • Diet: Reduce processed foods, saturated fats, and sugar; increase vegetables, lean proteins, and whole grains.
    • Exercise: Aim for 150 minutes of moderate exercise per week (e.g., brisk walking).
    • Weight management: Losing 5–10% of body weight can significantly improve results.
    • Alcohol reduction: Encourage moderation to protect the liver.
  • Medication discussion (if required):
    • “If lifestyle changes don’t improve cholesterol, we may consider a statin.”
    • “Metformin might be an option if glucose levels continue rising.”
  • Follow-up plan:
    • Review progress in 3 months, with repeat blood tests.
    • “If cholesterol remains high despite changes, we can discuss other options.”

SUMMARY OF A COMPETENT ANSWER

  • Explains blood test results clearly, addressing patient concerns.
  • Identifies pre-diabetes, hyperlipidaemia, and fatty liver as key issues.
  • Discusses risk factors, including family history and lifestyle.
  • Provides a structured management plan, including follow-up tests and lifestyle changes.
  • Encourages patient involvement, ensuring shared decision-making.

PITFALLS

  • Failing to explain results clearly, leading to patient confusion.
  • Over-reassuring without action, missing an opportunity for early intervention.
  • Neglecting family history of heart disease, underestimating cardiovascular risk.
  • Not discussing lifestyle changes in detail, limiting patient motivation.
  • Focusing only on medications without exploring lifestyle interventions first.

REFERENCES

MARKING

Each competency area is assessed on the following scale from 0 to 3:

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

Competency Areas Assessed

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, and expectations.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Takes a comprehensive history of risk factors and symptoms.
2.2 Identifies potential causes of abnormal blood results.
2.3 Determines when further investigation or follow-up is required.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises pre-diabetes, dyslipidaemia, and fatty liver based on results.
3.3 Determines when lifestyle changes or medical management are needed.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an appropriate management plan, including lifestyle advice.
4.3 Provides patient-centred education on diet, exercise, and risk factor control.
4.5 Refers for further investigations or specialist review as necessary.

5. Preventive and Population Health

5.2 Discusses cardiovascular risk reduction and metabolic health.

7. General Practice Systems and Regulatory Requirements

7.2 Follows appropriate guidelines for pathology follow-up and recall.

Competency at Fellowship Level

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