MRCGP SCA Consultation Skills Course
Station 13 · Low mood
Video consultation · Mental health · Gender, reproductive and sexual health · Prescribing · Circuit 3 · 13:15–15:15 · 20-minute station
A 34-year-old has run out of sertraline, wants signing off, and mentions — as if it hardly matters — that her period is late.
Candidate brief
Read this as you would in the exam. One to two minutes' reading, then ten minutes. You may ask the patient for examination findings; there is no reference material.
| Patient | Priya Shah, 34, accounts clerk |
| Reason for appointment | "Repeat sertraline; fit note" (booked by patient) |
| PMH | Depression 2019 (recovered). Nil else |
| Medication | Sertraline 50 mg od — 8-week supply issued 11 weeks ago by a colleague; review at 4 weeks not attended. Allergies: none. Contraception: none recorded |
| Recent entries | 11 weeks ago: 'Mother died suddenly 3 weeks ago. Low mood, poor sleep, tearful. PHQ-9 17. No suicidal ideation. Started sertraline 50 mg. Fit note 2 weeks. Bereavement leaflet.' No entries since. Fit notes: self-certified, then 3 weeks |
Role-player script — tutors only
Delegates: please do not open this section until you have consulted at this station.
Open the role-player script (497 words)
Persona and manner
- Tired, flat, apologetic for 'wasting time'; tears close but controlled; folds and unfolds a tissue.
- She has three things to say and expects to be allowed one.
Opening line — say this verbatim
- "I've run out of my sertraline — could I have some more — and I need to be signed off, I can't face going back yet. And… my period's late. I'm not sure it matters."
Volunteer freely if given the space
- Mum died in June — 'a heart attack, on the phone to me'. 'I'm not sleeping.' 'I cry at work.' 'My manager's been OK but I can't concentrate.'
- The tablets 'ran out five days ago and this week's been worse'.
Only if asked
- Took sertraline daily until it ran out; no side-effects; mood 3/10; nothing enjoyable; sleep four hours; appetite poor; concentration poor; guilt — 'I wasn't there'.
- Thoughts that 'it would be easier not to wake up' — no plan, no intent; 'I'd never do it — Dad needs me'; no self-harm; no previous attempts; no alcohol excess (two glasses of wine at weekends); no drugs.
- Period ten days late; normally regular; no contraception — 'we weren't really trying, but we weren't not'; partner supportive; no test done; no nausea; breasts 'a bit sore'.
- Returned to work for two weeks in August 'and it was awful'; off three weeks since; wants four weeks; a phased return 'might be OK if they'd let me'.
- Father lives alone; she visits daily; only child. Has not used the bereavement leaflet — 'it's in a drawer'.
- If pregnant: 'I'd be happy… I think. Would the tablets hurt it?'
Ideas, concerns and expectations
- Idea: 'grief — and I stopped the tablets and it's all crashed'.
- Concern: sertraline harming a pregnancy; being 'signed off means I've failed'; her father coping.
- Expectation: sertraline, a note, and 'to know what to do about the period'.
Cues to deliver, timed
- Minute 1: 'I'm not sure it matters' — the period.
- Minute 4: 'easier not to wake up' — only if mood is explored properly; otherwise at minute 7 if asked 'anything else?'.
- Minute 6: 'Dad needs me.'
How to respond to the doctor's plan
- If the doctor names all three agendas and orders them, assesses depression and risk properly, explains the discontinuation effect and restarts sertraline (safe in pregnancy; do not stop), arranges a pregnancy test today and folic acid, negotiates the fit note (two weeks with review, or 'may be fit' with a phased return) and separates sick leave from failure, offers bereavement support and talking therapy, safety-nets and reviews in one to two weeks: relief, brief tears — 'so I don't stop the tablets if I'm pregnant?' and 'can I have a note for two weeks and see you?'
- If the doctor issues sertraline and a four-week note in three minutes and moves to the period: at minute 8 — 'I don't think you asked how I actually am.'
- If the doctor stops sertraline 'in case you're pregnant': 'but I feel awful without it…'
Do not
- Volunteer the passive suicidal thoughts without a proper mood assessment.
- Accept a plan that ignores any one of the three problems without the cue above.
Mark scheme
Delegates: open after your consultation. Examiner-observers: open during it.
Generic mark scheme — identical at every station
Domain grades
| Domain | CF (0) | F (1) | P (2) | CP (3) | Points |
|---|---|---|---|---|---|
| Data Gathering and Diagnosis | ☐ | ☐ | ☐ | ☐ | /3 |
| Clinical Management and Medical Complexity (×1.5) | ☐ | ☐ | ☐ | ☐ | /4.5 |
| Relating to Others | ☐ | ☐ | ☐ | ☐ | /3 |
| Total | /10.5 |
Global rating: ☐ Fail ☐ Bare Fail ☐ Bare Pass ☐ Pass (CF Clear Fail · F Fail · P Pass · CP Clear Pass)
Feedback statement(s) — tick the one (at most two) you would attach
| Domain 1 | Domain 2 | Domain 3 |
|---|---|---|
| ☐ 1.1 Insufficient data | ☐ 2.1 Referral | ☐ 3.1 Cues / listening / formulaic |
| ☐ 1.2 Notes not used | ☐ 2.2 Prescribing | ☐ 3.2 Agenda / beliefs |
| ☐ 1.3 Psychosocial | ☐ 2.3 Investigations | ☐ 3.3 Circumstances / culture |
| ☐ 1.4 Unsystematic | ☐ 2.4 Prevention | ☐ 3.4 Explanations |
| ☐ 1.5 Prioritisation | ☐ 2.5 Risk management | ☐ 3.5 Judgemental |
| ☐ 1.6 Implications of findings | ☐ 2.6 Co-morbidity | ☐ 3.6 Respect / sensitivity |
| ☐ 1.7 Differentials | ☐ 2.7 Uncertainty | ☐ 3.7 Ownership |
| ☐ 1.8 Diagnosis / decision | ☐ 2.8 Follow-up / safety-net | ☐ 3.8 Teamwork |
| ☐ 2.9 Time management | ☐ 3.9 Safeguarding |
Timing checkpoints (Observer)
| Checkpoint (10-minute frame) | Done | Minute |
|---|---|---|
| Patient allowed to open without interruption (≈1 min) | ☐ | |
| ICE and psychosocial context elicited by 3:30 | ☐ | |
| Red flags covered; examination findings requested by 5:00 | ☐ | |
| Working diagnosis verbalised; gear change by 5:00–5:30 | ☐ | |
| Options shared; patient's preference used | ☐ | |
| Specific safety-net and follow-up by 9:30 | ☐ | |
| Understanding checked; finished inside 10:00 | ☐ |
Key points for this station — customised standard
Key points for this station
| Domain | Pass requires | Clear Pass adds | Fail if |
|---|---|---|---|
| Data Gathering & Diagnosis |
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| Clinical Management & Medical Complexity |
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| Relating to Others |
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Global rating guide: Pass = three agendas handled, risk assessed, safe prescribing, note negotiated, follow-up.
Teaching points
- NICE NG222 depression: continue antidepressants at least six months after remission; discontinuation symptoms appear within days of stopping sertraline. Sertraline is a reasonable choice in pregnancy and breastfeeding; do not stop abruptly.
- Fit notes: 'may be fit for work' with adjustments or a phased return is often kinder than four weeks off; a short note with review keeps continuity.
- Statement 1.5 (prioritisation): say the three things back — 'the tablets, work, and the late period — let's start with how you've been.'
Guidelines for this station
Your reflection
Record your grades, the statement attached, what you will keep and change, and your own reflection. Your entry is emailed to you as a record of this station; this page stays live so you can revisit the full case during revision.
Write my reflection for Station 13
Revision link for this case: mdacumen.com/sca-station13-low-mood
Editorial stamp · MRCGP SCA Consultation Skills Course · Station pages v1.0 · 11 September 2026 · Prof Rajesh Varma, Course Director · MD Acumen. Formative training material; not a prediction of exam performance. Not for onward distribution.