You are an FY2 in a GP surgery

Personal Details:

Name: Helen Jones

Age: 30

Medical Record:

Past medical history: None.

Regular medication: None.

Allergies: None known.

Notes:

Helen’s 5-year-old daughter was diagnosed with chickenpox three days ago. Helen has come to the GP surgery with some concerns.

Task:

Take a focused history, including Helen’s own immunity status to chickenpox, and address her concerns.

Opening Sentence: “Hi, Doctor, I need a sick note for work. My daughter has chickenpox, and I don’t want to spread it to my colleagues.”

Open History (to give freely): “My daughter came out in the spots three days ago. I’m looking after her at home, but my work needs a doctor’s note if I’m off. I work in a big supermarket, so I see a lot of people. It doesn’t feel right to go in.”

Cues to give: “I’ve had chickenpox myself, years ago.”

ICE (Ideas, Concerns, Expectations):

Ideas: “I think if you’ve been in contact with chickenpox, you can carry it and give it to others, even if you don’t get ill.”

Concerns: “Will I get chickenpox again? I’m worried I will infect other people, especially pregnant women or vulnerable customers.”

Expectation: “I expect you to give me a sick note for a week or so until my daughter is better.”

How to Act: You are a responsible, sensible person who believes you are doing the right thing. You are not demanding, but you are firm in your belief that you should not be at work.

More History (only if asked): You had chickenpox as a child and remember it clearly. You are feeling perfectly well yourself, with no fever, rash, or any other symptoms. Your daughter is recovering well.

Social History: You work on the checkouts at a large supermarket. You live with your husband and daughter.

Questions to ask:

But are you sure I can’t pass it on? What if I touch something and someone else gets it?

So you won’t give me a sick note? What am I supposed to tell my work?

Opening & Confirming the Request

Hi Mark. You’ve requested a sick note. Can you tell me why you need one?

History of Contact and Current Health: I’m sorry to hear your son is unwell. When did his chickenpox rash first appear? And how are you feeling in yourself right now? Do you have any symptoms at all - fever, headache, any spots?

Are you certain you’ve never had chickenpox in the past?

Occupational History: What is your job? Does your work involve contact with vulnerable people, like pregnant women or people with immune system problems?

ICE (Ideas, Concerns, Expectations):

What is your understanding of when someone with chickenpox becomes infectious?

What’s your main concern here - is it about your health, or the situation with your job?

You’re expecting a sick note for two weeks.

What’s your understanding of what that’s for?

Explain the situation, the likely diagnosis or DD:

Hi Helen, thank you for coming in. It’s very responsible of you to be thinking about the risk to others at your workplace. It’s completely understandable to be concerned, especially when you work with the public.”

Addressing and answering the patient’s ICE:

Your main concern is that you could carry the virus and pass it on to others, even though you feel well. Let me reassure you on that point. The most important fact here is that you have had chickenpox before. This means you are immune. Your body has antibodies that fight off the virus, so you cannot get it again, and more importantly, you cannot pass it on to anyone else. The virus is spread through coughs and sneezes or direct contact with the blisters from someone who is actively ill with chickenpox. It cannot be carried by an immune person.”

Next Steps:

Because you are immune and you are not ill, there is no medical reason for you to be off work. Public health guidelines are very clear that contacts of chickenpox who are immune do not need to stay away from work or school. Therefore, I’m afraid I cannot issue you a medical sick note, as that can only be issued for someone unwell themselves.”

Self-help measures:

I understand this puts you in a difficult position with your work. The issue here is not a medical one, but a practical one of needing time off to care for your daughter. This is something you would need to discuss with your employer. Most workplaces have policies for emergency leave for dependents or parental leave. You can explain to them that you are not ill and do not pose an infection risk, but that you require time off for childcare.

What I can do is provide you with a letter or a note that explains the public health guidance. It can state that you have been in contact with chickenpox, but that, as you are immune, you pose no risk to the public and are medically fit to be at work.

This might be helpful for your conversation with your employer. How does that sound?

Addressing ideas, concerns, and expectations: Clearly explain the concept of immunity and the transmission of the chickenpox virus. Correct her misconception that she can be an asymptomatic carrier.

Gently but firmly decline the request for a sick note, explaining the legal and ethical reasons why. Reframe the problem as a social/employment issue (childcare) rather than a medical one. Offer a pragmatic alternative (a letter explaining the guidance) to help her negotiate with her employer.

What is scenario testing? This case tests the candidate’s ability to negotiate with a patient and refuse a request in a polite but firm manner. It requires clear communication of public health principles and the ability to differentiate between medical fitness for work and social reasons for absence. The key is to be supportive while upholding professional and legal standards.