Explain somatic symptom disorder and a collaborative care plan — CASC communication station

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient/C-L clinic. [2]

Candidate instructions. Explain SSD in plain language without dualism, outline a collaborative stepped plan (scheduled GP care, CBT, treat depression), address the request for another immediate whole-body scan with red-flag safety-netting, and check understanding. The examiner plays the patient. [1][2]

Candidate scenario

Your patient has multi-system symptoms, high health anxiety behaviours (checking, ED visits), moderate depression, and extensive prior negative investigations without progressive disease markers. You plan: validation; SSD working diagnosis; GP-coordinated scheduled reviews; CBT for health anxiety/symptom focus; discuss an SSRI such as sertraline starting at 25–50 mg orally daily with monitoring if depression/anxiety treatment is agreed; agree symptoms that should prompt urgent medical review. They believe another scan today is the only path to safety. [1][3][5]

Marking domains

• Empathy, structure and agenda-setting
• Accurate plain-language both–and model (symptoms real; attention/threat loops amplify disability)
• Clear explanation that SSD is not “faking” and does not require medically unexplained as the sole logic
• Stepped plan: scheduled visits, CBT rationale, mood treatment discussion
• Handling scan request: limits of unfocused testing + red-flag re-open criteria
• Safety-net for suicide/mood worsening and medical red flags
• Checks understanding / teach-back [2][3][4]

Actor prompts (optional)

Common challenges: “So you think I am crazy?”; “If you refuse the scan and I have cancer, it is your fault”; “My partner says doctors never listen”; “I only feel safe in ED.” Respond with validation, both–and explanation, and red-flag safety-netting rather than dualism or collusion with unfocused imaging.[1][2]

Post-station notes

Examiners reward non-defensive validation, accurate nosology, and a concrete anti-iatrogenic plan. Fail modes: dualism (“all in your head”), colluding with endless unfocused imaging, or abandoning medical safety-netting.[2][5]