AKT – Medicolegal

Stephen Mallory, aged 49, presents for a scheduled opioid prescription review. He has been on long-term oxycodone for chronic back pain following a workplace injury five years ago. You note early refill requests in the past three months. During the consultation, Stephen becomes angry when asked about his medication use and refuses consent for a urine drug screen.

He insists on receiving a new script immediately and threatens to make a complaint if you don’t prescribe. You are concerned about potential misuse and diversion.

What is the MOST appropriate next step in management?

Margaret D’Souza, aged 82, is brought in by her daughter who is concerned about recent memory loss and difficulty managing finances. Margaret denies any issues and refuses cognitive testing. She insists she is capable of making her own decisions and does not want her daughter involved.

On examination, Margaret is well-groomed, oriented to time and place but struggles with short-term memory tasks. You suspect early dementia but capacity is uncertain.

What is the MOST appropriate next step?

Jackson Tran, aged 16, presents requesting confidential advice regarding contraception. He is sexually active and does not want his parents to know. He appears mature and engages well in the consultation. He requests a script for the oral contraceptive pill for his partner.

There are no concerns about coercion or abuse. He understands the risks, benefits, and alternatives.

What is the MOST appropriate action?

Karen Lam, aged 38, contacts your clinic to request a copy of her full medical records. She has recently moved interstate and is transferring care. You note she previously had mental health consultations and sensitive family history documented in her notes.

You are concerned some of this information may be misinterpreted if taken out of context.

What is the MOST appropriate response?

Dr William Huang, a GP registrar, has been seeing a patient, Emily Jenkins, aged 27, for the past 12 months. During this time, they developed a close rapport and he recently began a sexual relationship with her. He feels this was mutual and occurred after she stopped attending his clinic.

What is the MOST appropriate statement regarding this situation?

George Sotiropoulos, aged 77, presents with his son to discuss driving safety. George has early Alzheimer’s disease and recently got lost while driving to the local shops. His MMSE score today is 22/30. He is otherwise physically well and insists he is a safe driver.

You are concerned about his cognitive impairment and the risk to public safety.

What is the MOST appropriate next step?

Natalie Barker, aged 29, is a new patient who discloses during a routine consultation that she experienced sexual abuse as a child from a now-deceased family friend. She is not currently at risk, but this is the first time she has spoken about it. She is tearful and asks you to keep this information confidential.

What is the MOST appropriate response?

Dr Jonathan Mead, a GP, has received a request from a solicitor asking for a detailed medical report about his former patient, Linda Chau. The letter includes a signed patient consent form and indicates the information will be used for a personal injury claim. Dr Mead no longer sees this patient.

What is the MOST appropriate action?

Leah Pinder, aged 34, presents with a minor foot injury. During the consultation, she discloses she is being emotionally abused by her partner. She says she feels unsafe at home and fears the situation may escalate. She is not ready to leave the relationship and asks you not to tell anyone.

What is the MOST appropriate next step?

Dr Samantha Walsh is conducting a telehealth consultation with a patient she has never met before. The patient requests a prescription for diazepam, citing anxiety and recent travel-related stress. No prior notes or history are available. The patient declines to turn on video and gives only minimal identifying information.

What is the MOST appropriate response?

Amira Bhatti, aged 33, is a nurse who presents requesting backdated medical certificates for three separate sick days over the past month. She states she was unwell on those days but did not see a doctor at the time due to shift work. She says her manager is demanding documentation for payroll purposes.

What is the MOST appropriate response?

Dr Lucia Mendes is conducting a Medicare-funded telehealth consultation with a patient she has previously seen in person. The patient consents to the consultation being conducted by phone. However, Lucia’s internet connection drops midway, and she finishes the consultation by mobile SMS to ensure the patient receives urgent script information.

What is the MOST appropriate documentation approach?

Lachlan Reid, aged 55, has requested a copy of his pathology results. You are concerned that one result may indicate cancer, and he has not yet been informed of this. He insists on receiving the full results immediately as he has a specialist appointment tomorrow.

What is the MOST appropriate response?

Brian Quoc, aged 67, recently diagnosed with advanced pancreatic cancer, has told you he does not wish to know his prognosis. His daughter, who attends today’s appointment with him, asks you privately afterwards to tell her exactly how long he has left.

What is the MOST appropriate action?

Dr Peter Mason is notified that a former patient, who he treated two years ago, has died unexpectedly. The coroner requests a copy of the patient’s full medical records.

What is the MOST appropriate response?

Alexei Novak, aged 45, presents for a routine review of hypertension. During the visit, he casually mentions that he sometimes drives home after ‘a few drinks’ and jokes that he has never been caught. You are concerned this may present a risk to public safety.

What is the MOST appropriate next step?

Fiona Greer, aged 38, is attending a shared antenatal care appointment. She mentions in passing that she has been forging her partner’s signature on Medicare forms to access services, as he is estranged and not involved. She requests that you do not tell anyone.

What is the MOST appropriate action?

Dr Naveen Patel receives a phone call from a private investigator asking if a patient, Hugo Quinn, attended the clinic last week. The caller claims it relates to an insurance claim and insists he already has most of the details.

What is the MOST appropriate response?

Georgia Simmons, aged 51, is a teacher who attends for medical clearance following a minor wrist fracture. She is seeking to return to work but expresses concern about occasional wrist pain. You believe she is fit for modified duties. Her employer has sent a standardised form requesting your opinion on fitness to work.

What is the MOST appropriate course of action?

Jerome Wallace, aged 20, presents to request a copy of his childhood immunisation records. His mother has always attended with him previously and he says she won’t approve of him accessing his own file. He is mentally well and provides photo ID.

What is the MOST appropriate response?

Dr Christine Foong is asked by her patient, Louis Keane, aged 36, to write a letter stating he cannot attend jury duty due to anxiety. Louis has no documented history of mental illness and appears well today. He says he ‘just can’t deal with courtrooms.’

What is the MOST appropriate response?

Amina Ismail, aged 17, presents alone requesting medical advice about termination of pregnancy. She is 9 weeks pregnant and does not want her parents to know. She understands the nature of the procedure and gives clear, reasoned responses to your questions. She is not at risk of harm or coercion.

What is the MOST appropriate course of action?

Dr James Ahn is completing a medical certificate for an insurance claim. His patient, Kelly Wong, aged 40, has exaggerated her symptoms during the consultation and asks Dr Ahn to ‘help her out’ by making it sound worse to improve her payout.

What is the MOST appropriate response?

Tahlia Brown, aged 4, is brought in by her father, who has limited English proficiency. He wants to know if Tahlia is ready for preschool and requests a general health check. During the examination, you note bruising in multiple stages of healing on her upper arms and back. The father says she is clumsy.

What is the MOST appropriate action?

Thomas Nguyen, aged 62, attends for his usual diabetes review. At the end of the consultation, he asks you to write a letter confirming that he was ‘fit to travel’ two weeks ago, when he went interstate to visit family. He says it’s for travel insurance purposes. You did not see him at the time.

What is the MOST appropriate response?

Sarah O’Leary, aged 25, presents with concerns about her housemate, who has been making suicidal comments and has stockpiled medications. Sarah is not a patient of yours, and her housemate is unknown to the practice. She asks for advice and wants you to intervene urgently.

What is the MOST appropriate course of action?

Jaspreet Singh, aged 72, attends with his adult daughter. During the consultation, Jaspreet frequently looks to his daughter for answers and seems unable to understand parts of the discussion. You suspect mild cognitive impairment and are concerned about his ability to consent to treatment.

What is the MOST appropriate next step?

A patient you treated for work-related stress submits a complaint to AHPRA claiming your management was inadequate. You receive formal notification and feel shocked and anxious. This is your first professional complaint.

What is the MOST appropriate immediate action?

Carlos Mendieta, aged 29, presents for medical clearance to participate in a boxing match. He has a history of mild asthma and had a concussion six months ago, from which he fully recovered. You are unsure of current fitness standards for his sport.

What is the MOST appropriate course of action?

Melissa Tran, aged 48, presents to review recent pathology results. She mentions in passing that she has been forging her husband’s signature on repeat prescription forms so she can pick up his medication without him knowing. You are concerned about this disclosure.

What is the MOST appropriate next step?

Rachel D’Souza, aged 30, is a GP registrar. During a consultation, a patient gives her a small handmade gift as thanks for her care. Rachel is unsure whether to accept it, as she’s heard conflicting advice from colleagues.

What is the MOST appropriate course of action?

Leo McGrath, aged 22, is referred by his employer for a workplace medical after sustaining a minor eye injury. You are asked to assess fitness for duty and provide a report. During the consultation, Leo discloses recreational drug use and begs you not to include this in the report.

What is the MOST appropriate response?

Helena Kirk, aged 69, presents with her granddaughter, who acts as her carer. You suspect Helena has early dementia and are unsure whether she understands the risks and benefits of a proposed new medication. The granddaughter insists she will handle the consent process.

What is the MOST appropriate action?

A colleague confides in you that they have been drinking heavily and occasionally seeing patients after consuming alcohol. They ask you to keep it confidential and not report it.

What is the MOST appropriate response?

Dean Russell, aged 39, attends for an employment medical to work in aviation. He appears nervous and avoids questions about mental health. You find a history of treated depression in his file, which he denies during the assessment.

What is the MOST appropriate course of action?

Gabriel Tan, aged 8, presents with his mother for a follow-up of his asthma. During the consultation, Gabriel says quietly that his stepfather hurts him when mum isn’t around. There are no visible injuries. His mother is unaware of this disclosure and steps out briefly to take a call.

What is the MOST appropriate immediate action?

Margot Lee, aged 62, has a long history of schizophrenia and attends with her case worker. She appears stable and is adherent with her medication. She requests a copy of her entire mental health file to support a Centrelink claim. Her case worker expresses concern that reading the records may distress her.

What is the MOST appropriate action?

A patient, James Park, aged 34, presents with fatigue and admits to injecting anabolic steroids sourced online. He asks you to ‘keep it off the record’ as he is concerned about losing his job if it’s documented. He is otherwise well and requests regular blood monitoring.

What is the MOST appropriate response?

During a busy morning clinic, Dr Liz Hardy realises she mistakenly prescribed methotrexate 10 mg daily instead of weekly for a patient with rheumatoid arthritis. The patient has not yet filled the script. What is the MOST appropriate immediate action?

Rohan Iyer, aged 45, is undergoing an occupational medical examination for heavy vehicle driving. You suspect poorly controlled diabetes and find evidence of diabetic retinopathy in correspondence from his optometrist. He insists you omit this information as it may affect his licence.

What is the MOST appropriate response?

Jeanette Wu, aged 73, presents for a home medication review. During the visit, her son, who lives with her, asks to speak privately. He discloses financial stress and says he sometimes uses her pension card to buy groceries and pay bills without her knowledge. He appears distressed and asks for your advice.

What is the MOST appropriate action?

Dr Hannah Ellis is asked by her friend, who is a nurse, to prescribe antibiotics for a urinary tract infection. They are on a weekend trip together and the nurse doesn’t want to see a doctor formally. She describes typical symptoms, and Dr Ellis has known her for years.

What is the MOST appropriate response?

Amanda Buckley, aged 50, contacts your clinic to express concern about her ex-husband accessing their child’s medical records. She shares care of 12-year-old Benjamin and has primary custody. She is concerned he will use the information in a custody dispute. The father has not been violent and has parental responsibility.

What is the MOST appropriate response?

Dr Raj Khanna is asked by police to provide blood alcohol results for a patient involved in a car accident. The patient is conscious and refuses consent. The police present a formal request under state legislation to obtain the information.

What is the MOST appropriate response?

Jessica Cho, aged 14, presents for the HPV vaccine and asks that her parents not be informed. She appears mature and understands the procedure, risks, and benefits. She is otherwise well and up-to-date with routine vaccines.

What is the MOST appropriate action?

Kevin Wang, aged 46, presents for review of a recent injury sustained at work. You are asked to complete a WorkCover certificate. Kevin asks you to write that the injury was worse than it is, stating it will help him get compensation and time off. On examination, his injury appears mild and improving.

What is the MOST appropriate action?

Lauren Nikolic, aged 29, presents with a request to change her name and gender on her medical record. She recently began gender-affirming care and says her previous GP refused to update her file. She provides legal documentation of her name change and affirms her gender identity.

What is the MOST appropriate action?

Dr Erica Morris receives a call from a journalist seeking comment about a patient who was recently in the media. The journalist claims the patient is under her care and wants confirmation and further detail. Dr Morris recognises the name as one of her regular patients.

What is the MOST appropriate response?

Miles Anagnostou, aged 61, presents for follow-up after a hospital admission. You notice a recent CT report in the shared care summary that he has not yet seen, which mentions a possible pancreatic lesion requiring urgent outpatient review. Miles is unaware of the finding and says the hospital didn’t explain much at discharge.

What is the MOST appropriate action?

Dr Shaun Patel is completing an insurance medical for a patient. During the process, the patient discloses a history of past suicide attempts which is not documented in previous records. The patient insists this information not be included in the report. The form requires full psychiatric history.

What is the MOST appropriate action?