You are an FY2 in a GP surgery  

Personal Details:

Name: Sarah Jenkins

Age: 33

Medical Record:

Past medical history: Asthma (mild), depression

Regular medication: Salbutamol inhaler as required, citalopram 20mg OD

Allergies: None known.

Notes:

A 33-year-old lesbian woman wants to discuss starting a family with her partner.

Task:

Take a focused, address concerns and discuss management options.

Opening Sentence: “Hi, Doctor. My wife and I have decided we’d like to start a family, and I’ve come to talk about how we'll go about that.”

Open History (to give freely): “We’ve been together for six years and feel ready to have a baby. I would be the one to carry the pregnancy. We’d like to know more about the process.”

Cues to give: “Is there anything I need to do to get myself ready for pregnancy?”

ICE (Ideas, Concerns, Expectations):

Concerns: “Are there any health checks I should have first? I had depression a while ago. Could that be a problem?”

Expectation: “I’d like to know about the process and what I should be doing to prepare.”

How to Act: You are excited, well-informed, and proactive. You are looking for practical advice and a clear plan.

More History (only if asked): Your periods are regular. You have never been pregnant. Your smear tests are up-to-date and have always been normal. You used to smoke but quit a year ago. Your asthma is very mild and well-controlled. You are no longer on antidepressants.

Social History: You are a lesbian, and you are in a stable 6-year marriage.

Questions to ask:

“So what’s the first step?”

“Do I need to start taking any vitamins?”

Opening & Establishing Goals:

It’s wonderful that you’re planning to start a family. This is a really exciting time. To start, can you tell me what you already know and what you’d like to find out today?

Exploring Wishes and Understanding: Have you had any thoughts about who would like to carry the pregnancy? What have you read or heard about the available options?

Brief Medical & Social History: To give you the best advice, I need to ask a few health questions.

Are your periods regular? Do you get any unusual pain with your period? Have you ever been pregnant or had any miscarriages before?

Do you smoke?

Sarah, that’s wonderful news! It’s a very exciting time for you and your wife. It’s great that you’ve come in to discuss this beforehand. We call this pre-conception counselling, and it’s all about making sure you are as healthy as possible before you get pregnant.

Addressing and answering the patient’s ICE:

You’re asking about the process, and you are right, you will need to be referred to the fertility clinic. As you have a female partner, you will need a sperm donor from a sperm bank. The fertility team will be able to explain the process of how to get that.

The waiting list can be quite long, so some couples consider going privately.

We will need to arrange a routine blood test for you, check your weight, height and blood pressure to attach to the referral.

Answer the patient's question

You asked what you can do to prepare, and this is the most important part. You should start taking a folic acid supplement every day, ideally for three months before you conceive. It’s also important to ensure your asthma is well-controlled and that you are up-to-date with your smear tests and other health checks.

It’s fantastic that you’ve already stopped smoking. We also advise cutting out alcohol while you are trying to conceive.”

Regarding your previous history of depression, it’s good that you are feeling well now. Pregnancy can be an emotional time, so it’s important to be aware of your mental health and to know that there is support available if you start to feel low again.

Addressing ideas, concerns, and expectations: Provide clear information about accessing fertility services. Reassure her about her past mental health history.

The management is advice and health promotion. 1. Advice to take folic acid. 2. Advise on lifestyle (alcohol). 3. Offer baseline blood tests (e.g., rubella status). 4. Refer to the fertility clinic for counselling.

What is scenario testing? This is a health promotion and counselling station. It tests the candidate’s knowledge of pre-conception advice and their ability to provide information and support to a same-sex couple. The communication should be positive, supportive, and non-judgmental. The key is to provide a structured plan of actionable steps for the patient.