Age: 15 years old female

Examiner

Station List
Doctor
Patient
Full Case

Marking Scheme

Data Gathering and Diagnosis

  • Ask about the incident: Can you tell me exactly what happened that night? (e.g., where were you, who was present, what did you take?)
  • What drug did you take? Were you aware it was MDMA/ecstasy or was it something else?
  • Did you feel pressured or uncomfortable when your boyfriend offered you the drug?
  • How much of the drug did you take, and how long after taking it did you pass out?
  • Did anyone else take the drug as well? Were they affected in the same way?
  • What do you remember happening before you passed out?
  • Do you know how long you were unconscious for, and where were you when you woke up?
  • Do you feel there are memory gaps? –GHB (sometimes used as a date-rape drug), can cause blackouts or memory loss)
  • Ask what happened after she woke up- did you notice any injuries or pain down below? Any bleeding or discharge down below? –this is to check if rape happened 
  • Ask if she is worried that something might have happened to you while you were unconscious, such as sexual activity or assault?
  • Ask about the boyfriend, how old is he? how does she feel about her relationship with the boyfriend? Does she feel safe with him?
  • Ask if boyfriend has ever pressured her into doing things she didn’t want to do, such as taking drugs or anything else?
  • Ask if she is sexually active? If yes, does she use any contraceptives? If no, ask for LMP and if there is any chance, she could be pregnant 
  • Ask patient if this is the first time she has taken drugs? 
  • Ask how she feels about having taken the drug? Do you regret it or feel like it was a mistake?
  • Ask if she smokes, takes alcohol etc
  • Ask about school and if any issues in school 
  • Ask about home situation—who lives at home, if she has spoken to her parents

Management

  • Thank patient for coming and opening and re-assure her that you are here to help her. 
  • Given the fact that patient passed out after drug use and the fact that her parents are uninvolved in her life heightens her vulnerability and therefore a safeguarding is needed 
  • Explain to her calmly: Chloe, I really appreciate you sharing this with me. I want you to know that you’re not in trouble, and I’m not here to judge you. Street drugs are harmful, and we discourage people from getting involved.  What’s most important to me is that you’re safe, both physically and emotionally.”
  • “You’ve told me about some things that raise concerns about your safety, like passing out after taking the drug and not remembering parts of the night. Because you’re still young and there are risks involved, I’m required to take extra steps to make sure you’re protected.”
  • “That’s why I need to involve a team who can provide extra support. They’re called safeguarding, and their job is to help young people like you who may be in vulnerable situations. It doesn’t mean anyone’s in trouble—it’s just about making sure you’re safe and getting the right support, especially if things have happened that you didn’t want or didn’t expect.”
  • Offer face to face assessment if she is worried about rape or has any concerns—if not, no need to
  • Offer her STI screen (Signpost to sexual health clinic) and another appointment to discuss contraception—offer her leaflets for contraception
  • Follow up in 2-4 weeks’ time to see how she is doing.

Learning point from this station: ​

This station highlights the importance of recognising safeguarding concerns in adolescents, particularly when they present with vulnerabilities such as drug use, blackouts, limited parental involvement, and possible coercion in relationships. Even in the absence of overt abuse or physical symptoms, a history like Chloe’s raises red flags that warrant early intervention and support.

In such situations, GPs must maintain a calm, non-judgemental, and confidential environment to build trust and encourage disclosure. It’s critical to balance confidentiality with safeguarding obligations—explain to the young person that while most of the consultation remains private, there are times you may need to involve specialist teams if safety is at risk.

The station also reinforces the need to:

  • Know how to safely explore sensitive topics like substance use, consent, and relationships in young people.
  • Recognise that passing out or memory gaps after suspected MDMA or GHB use may suggest accidental overdose or potential abuse.
  • Recognise that limited parental involvement may mean that future drug use is likely 
  • Understand that safeguarding is not punitive—it’s a supportive process aimed at ensuring the young person’s wellbeing and protection.
  • Offer appropriate follow-up, such as STI screening, contraception advice, and regular reviews to ensure the patient feels supported and not abandoned after disclosure.

Ultimately, safeguarding is everyone’s responsibility, and early recognition and action can make a significant difference in a young person’s life.