PESCI panels draw their scenarios from the presentations a general practitioner must manage safely alone, and the same ones recur across providers because they are the ones where a doctor new to Australian practice could harm a patient. This guide covers the scenarios that recur and the structure that scores against the criteria.
The structure for every scenario
Assess: the history that matters, the examination, the red flags. Decide: what is going on and how urgent it is. Manage: what you would do in the practice, with the Australian guideline. Refer: when and where, and by ambulance if the patient is unstable. Safety net: what you would tell the patient and when you would see them again. Document: what you would record and who you would tell. Say each step aloud; the criteria follow this order.
The chest pain in the clinic
A 55 year old man with central chest pain for an hour. Recognise the emergency: the ambulance called early, aspirin, the ECG if the practice has one, oxygen only if hypoxic, analgesia, monitoring, and the transfer. The history and examination that matter. The safety net if the pain settles and he wants to go home: he does not go home. Say what you would document and who you would tell. The probe: he refuses the ambulance.
The febrile child
A two year old with a fever of 39, miserable but drinking. The assessment of a febrile child: the observations, the source, the red flags including the rash, the capillary refill, the breathing, the hydration. Treat what you find, give safety netting with the signs that mean return or an ambulance, arrange review. Say when you would send the child to hospital. The probe: the mother is from a remote community and will not be able to return easily.
The patient with low mood
A 40 year old woman who has felt low for months and sometimes thinks she would be better off dead. Ask directly: intent, plans, means, previous attempts, protective factors, substance use. Assess the depression and the risk. Decide: a safety plan and close follow up with the mental health team, or urgent referral and the crisis service. Know the state's pathway. The probe: she refuses help.
The urgent result and the unanswered phone
A potassium of 6.8 on a patient seen yesterday who is not answering. The result is urgent and the practice is responsible until the patient is reached: keep calling, the emergency contact, consider whether the result is real, and if the patient cannot be reached, the police welfare check or the ambulance by the risk. Say what you would document and how the practice's results system should prevent this.
The complex chronic disease review
A 70 year old with diabetes, hypertension and kidney disease on eight medications. What matters to the patient, then the review: each condition against targets, the medications for interactions and renal dosing, the preventive care due, the care plan and the team, the follow up. Prioritise. Say which medication you would look at first.
Emergency contraception
A 25 year old two days after unprotected sex. The options and their time limits, the assessment, the infection screen, the ongoing contraception, the follow up. Non judgemental. The probe: she is sixteen.
Drugs of dependence
A 60 year old asking for his sleeping tablets and oxycodone, prescribed for years. Assess the indications and the dependence, check the prescription monitoring system, explain the risks, do not simply refuse or simply continue, agree a plan toward reduction with support, and know the state's regulations. Keep the relationship.
The cough with weight loss
Cancer until proven otherwise: the examination, the chest X ray now, the bloods, the urgent referral if abnormal, the safety net if normal. Say what you would tell the patient and how soon you would see them.
The limping child with a fever
Septic arthritis must not be missed: the examination, the bloods, the imaging, same day referral if the criteria are met. Say what you would not do.
The disclosure of family violence
Believe them, assess their safety and the children's, know the state's pathway and services, do not act beyond what they want unless a child is at risk, document carefully, arrange follow up. The probe: a child is at risk.
The collapse in the waiting room
The ambulance, the practice's emergency plan, the resuscitation equipment, basic life support and the defibrillator, delegation to the nurse and reception, and continuing until the ambulance arrives.
What the panel scores
Safe assessment, the right management, early referral where needed, clear safety netting, honesty about the limits of the role, and knowledge of the Australian system. The common failures are managing the emergency in the practice, no safety net, and not knowing the referral pathways.
Practising
Talk each scenario through aloud in the structure, against the time your provider allows, with someone who probes. Learn your state's pathways and services by name. The scenarios are predictable and the structure is learnable.