Few consultations test a registrar’s professionalism quite like the frequent attender. You see the name on the list, you recognise it, and a small part of you sighs before the consultation has even begun. That reaction is human, and learning to manage it is exactly what these cases, in the exam and in real life, are designed to surface.

The trap of the heart-sink reaction

The danger with a frequent attender is not clinical, it is attitudinal. The moment you decide, consciously or not, that there is “nothing really wrong,” your consultation changes. You ask narrower questions. You listen less. You move to reassurance and closure too quickly. And in doing so you risk two things: missing the occasion when something really is wrong, and leaving the patient feeling dismissed, which only makes them more likely to come back.

The skill is to meet each presentation with fresh curiosity, regardless of history. That does not mean ignoring the pattern, which is useful information, but it means not letting it close down your thinking before you have actually listened.

Ask why now

The most powerful question with a frequent attender is often the simplest: why today? Someone who attends often still chose this particular day to come. Sometimes the answer is the stated symptom. Often it is something underneath it: a fear that has resurfaced, a life event, a change at home, a piece of news about someone else. Exploring “why now” rather than just “what’s wrong” frequently uncovers the real agenda, and it is usually the thing that, if addressed, reduces the attendance.

What the exam is testing

In the SCA, a frequent-attender case is rarely about reaching a clever diagnosis. It is testing whether you can stay patient-centred under mild internal resistance — whether you explore ideas and concerns properly even when part of you has pre-judged, and whether you can build a plan that addresses the underlying driver rather than just batting away the surface complaint. The examiners are watching for the registrar who stays curious, not the one who reassures fastest.

Practising the internal discipline

This is partly a clinical skill and partly an emotional one, and the emotional part is the harder to train. It helps to rehearse these consultations deliberately: to practise noticing your own reaction and consciously setting it aside, exploring the presentation as if you were meeting it for the first time. The more you rehearse staying open under that quiet pressure, the more it becomes your default rather than something you have to summon. That discipline serves you far beyond the exam: the frequent attender will be a feature of every surgery you ever run.