SCA Exam Consultation: How to Ace Clinical Management and Medical Complexity Domain
Formulating Safe and Prioritised Management Plans
Strategy: Ensure your management plan is safe, evidence-based, and tailored to patients’ needs and preferences. Prioritise interventions based on clinical urgency while considering long-term health and self-management.
Tip: When managing multiple health conditions, prioritise the most pressing issues first and coordinate the treatment of chronic conditions.
Example:
- “Today, I think the most important thing is to manage your high blood pressure, but we’ll also work together on your diabetes in the longer term. Let’s start by adjusting your ramipril blood pressure medication and repeating your kidney blood test in 2 weeks.
Considering a “Wait and See” Approach
Strategy: Not all conditions require immediate intervention. A “wait and see” approach is sometimes appropriate, especially when symptoms are mild or self-limiting.
Tip: Always explain the rationale for this approach, ensuring the patient feels safe and supported while waiting for improvement.
Example:
- “Your ear infection seems mild right now, and it may resolve on its own without antibiotics. Let’s wait a few days and monitor your symptoms. If it worsens, we can review the situation and prescribe antibiotics if needed.”
Encouraging Self-Management and Lifestyle Modifications
Strategy: Empower patients by promoting self-care and healthy lifestyle choices. This encourages long-term engagement in their own health management.
Tip: Tailor advice to the patient’s situation and capabilities, offering practical, achievable steps for improvement.
Example:
- “For your asthma, keeping a symptom diary and using your inhaler regularly is key to managing it well. Let’s also talk about how stopping smoking could improve your lung function and overall health, Ali. Smoking Cessation could help improve your lung function and reduce the risk of heart and lung disease as well as reduce risk of lung cancer AIi.”
Applying National Guidelines and Safe Prescribing
Strategy: Always adhere to national guidelines (e.g., NICE) when prescribing or recommending treatments. Demonstrate knowledge of safe prescribing practices, including drug interactions and side effects.
Tip: Before prescribing, consider alternatives such as non-drug therapies and assess whether the benefits outweigh the risks, especially in multi-morbid patients.
Example:
- “According to NICE guidelines, we’ll start with a low-dose statin to help manage your cholesterol levels. It’s important to monitor for side effects, so we’ll do a blood test in three months to ensure everything is on track, Linda. I would also like to give you this PIL, which describes some of the possible side effects I mentioned earlier:”
Managing Uncertainty
Strategy: When managing uncertainty, acknowledge it early, maintain open communication, and provide reassurance. Emphasise patient safety and outline a clear plan for follow-up and monitoring. Use shared decision-making to involve patients in the process, reducing their anxiety.
Tip: Always explain your steps and provide safety-netting advice, ensuring the patient knows when to seek further help. This approach builds trust and offers reassurance.
Example:
- “I understand that not knowing exactly what’s going on can be stressful, Rebecca. At this stage, we don’t have all the answers, but that’s okay—we’ll run some tests and review your symptoms. Importantly, nothing right now suggests anything that is an emergency. If your symptoms change or worsen, please get in touch with us. We will arrange a follow-up appointment to reassess, but I’m here to support you as we work together. Rebecca, if you experience sudden SOB or CP or you can’t talk in full sentences, then ring 999 in emergencies and get to the nearest A&E.”
Key Points:
- Acknowledge uncertainty.
- Outline the next steps
- Reassure patient safety.
- Provide clear safety-netting advice.
Managing Polypharmacy
Strategy: For patients with multiple chronic conditions, prioritise interventions based on risk and clinical need. Be mindful of drug interactions and the burden of polypharmacy.
Tip: Review the patient’s medications regularly and aim to simplify treatment where possible. Discuss deprescribing if appropriate.
Example:
- “You’re currently taking several medications for your heart disease and diabetes. I want to review whether they’re all necessary and if there’s anything we can simplify. It’s important to avoid unnecessary side effects from too many medications, Gary.”
Referral and Resource Management
Strategy: When making referrals, consider resources and national guidelines. Only refer when necessary/appropriate, ensuring that patients receive the most appropriate care without overloading other healthcare services unnecessarily.
Tip: Clearly explain the reasoning behind a referral to the patient and ensure appropriate follow-up to maintain continuity of care.
Example:
- “I’d like to refer you to a specialist to investigate your ongoing stomach issues, as we have now covered the investigations needed to be done by us at the GP surgery, James. However, we will continue to monitor your symptoms closely here in the meantime.”
Tailored Follow-Up and Continuity of Care
Strategy: Provide appropriate follow-up based on the severity and nature of the patient’s condition. Ensure that care is coordinated across different services when necessary.
Tip: Safety net effectively by giving the patient clear instructions on when and how to seek further help if their condition worsens.
Example:
- “Let’s schedule a two-week follow-up to review your symptoms and blood test results. If you notice any worsening or new symptoms in the meantime, please get in touch with the surgery for an earlier review.”
Promoting Health and Managing Prevention
Strategy: Integrate health promotion into the consultation, whether it’s smoking cessation, diet, exercise, or mental well-being. Tailor the message to the patient’s circumstances and readiness to change.
Tip: Link health promotion efforts to the patient’s existing conditions and emphasise the long-term benefits of lifestyle changes.
Example:
- “Managing your diabetes will be much easier if we can work on improving your diet and exercise habits. Let’s set some realistic goals, like reducing sugar intake and aiming for 30 minutes of walking daily. This will help improve your overall health and diabetes control; how does that sound to Archie?.”
Incorporating Safeguarding and Holistic Care
Strategy: Always consider safeguarding issues, particularly in vulnerable adults or children. Actively engage with support agencies where needed and ensure appropriate referrals.
Tip: Safeguarding concerns should be handled sensitively, but if there’s a serious risk of harm, the patient’s safety should generally be prioritised over confidentiality.
Example:
- “I’m concerned about some of the things you’ve mentioned regarding your home situation, and I think it’s important to involve a support service to ensure you’re safe and getting the help you need, Alice.”
General Tips
- Address ICE in the management section
- Address Impact in the management section
- Opportunistic health promotion
- Involve the patient by asking what they think about the management suggestions
- Ensure referrals are appropriately explained to the patient and the time frame given
- If medication is prescribed, explain why, dose, frequency, significant side effects and monitoring
- Safety net effectively
- Follow up appropriately
Dr Sakaria Farah
PassCME Tutor
