You are an FY2 in GP surgery 

Personal Details:

Name: Sarah

Age: 25

Medical Record:

Past medical history: Fit and well.

Notes:

A 25-year-old woman reports experiencing a stressful time at work and seeks support.

Task:

1. Take history and address her concerns.

3. Discuss management options.

Opening Sentence: (Looking down, quietly) “Doctor, I don’t know what to do. I feel so anxious all the time.”

Open History (to give freely): “I started a new job six months ago, and it was fine at first. But for the last couple of weeks, a few of my colleagues have been making comments and jokes about me being gay. It’s horrible. Every morning, I wake up with my heart pounding, feeling sick at the thought of going in”

Cues to give: “I haven’t told anyone. Not my partner, not my boss. I don’t want to make a fuss.”

ICE (Ideas, Concerns, Expectations):

Ideas: “I feel like I’m going crazy. I think I just need to toughen up.”

Concerns: “What can I do about my colleagues? Is there any law that prevents discrimination at work? I’m worried about my drinking.”

Expectation: “I need some advice. I can’t carry on like this.”

How to Act: You are withdrawn, anxious, and have low self-esteem. You only open up when the doctor shows empathy and builds rapport.

More History (only if asked): You are in a stable relationship with your female partner of two years. You have never had mental health problems before. You used to be a social drinker, but the daily drinking is new.

Social History: In a same-sex relationship.

Questions to ask:

“What if they fire me if I complain?”

Opening & Building Rapport:

It sounds like you are very distressed. Thank you for coming to talk to me. Let’s take our time. Tell me what’s been happening.

Screening for Anxiety & Depression:

Over the last two weeks, how often have you been bothered by feeling nervous, anxious, or on edge?

Have you been having little interest or pleasure in doing things?

Are you feeling down, depressed, or hopeless?

Exploring the Cause (The Bullying):

You mentioned things are difficult at work. Can you tell me a bit more about that?

You said your boss is making your life hell. What sort of things have been happening?" (Listen patiently, validate her feelings).

Risk Assessment:

With all this stress, have you had any thoughts that life is not worth living, or any thoughts of harming yourself?

You mentioned drinking more wine. How much would you say you are drinking each night, or each week?"

ICE (Ideas, Concerns, Expectations):

You said you feel you are heading for a breakdown. What does that mean to you?

What is your biggest worry right now?

What were you hoping they would do for you?"

Acknowledge:

Sarah, thank you so much for telling me about this. It sounds like you are in a hugely difficult and stressful situation, and it takes a lot of courage to talk about it. What you are describing is a normal human response to being bullied and discriminated against. The anxiety and palpitations are physical symptoms of the stress you are under.

Addressing and answering the patient’s ICE:

You asked if there are laws to prevent this. Yes, absolutely. The UK Equality Act of 2010 makes it illegal for an employer or colleague to discriminate against or harass someone because of their sexual orientation. What is happening to you is illegal, and you are protected by law.

Next Steps:

Let’s talk about what we can do. We have two issues to tackle: the workplace situation and your health. For the workplace, you have several options. Most companies have a formal grievance procedure for bullying and harassment. You could speak to your line manager or someone in the HR department in confidence. They have a legal duty to investigate this. You could also get advice from an organisation like the ACAS helpline or a Citizens Advice Bureau. You should not have to ‘toughen up’ – they are the ones who need to change.

Self-help measures:

For your health, I am concerned about the amount you are drinking. Using alcohol to cope with anxiety is a slippery slope. Let’s think about better ways to manage the stress. I can sign you off work for a couple of weeks to give you some breathing space and time to think. We can also refer you for some talking therapy, like CBT, which can give you tools to manage the anxiety symptoms. It’s also really important that you talk to your partner; you need her support.

You’re worried about being fired if you complain. It would be illegal for them to fire you for making a formal discrimination complaint.

The first step is to give you some time and space away from the situation.

Offer a fit note

How would you feel about me signing you off work?

The management is holistic. 1. Offer a sick note to provide immediate respite. 2. Discuss referral for talking therapy (IAPT/CBT). 3. Address the harmful alcohol use. 4. Provide practical advice on addressing the workplace issue (HR, ACAS, keeping a diary). 5. Encourage her to confide in her partner.

What is scenario testing? This case tests the candidate’s ability to handle a sensitive consultation involving mental health and a social issue. It requires knowledge of the legal framework around workplace discrimination and the management of acute anxiety and harmful drinking. The key is to be supportive, empowering, and practical.