PLAB 1 NHS Protocols & Professional Practice — Questions and Answers
Question 1: A patient under your care develops a serious unexpected complication after surgery that may have been caused by a system failure. What is the most appropriate action under NHS duty of candour?
- Document the complication in the notes and await the patient's complaint
- Be open and honest with the patient and family, acknowledge what happened, offer an apology, provide information about any investigation, and explain what steps are taken to prevent recurrence (Correct answer)
- Seek legal advice before disclosing anything to the patient
- Inform the ward sister but not the patient until an internal review is completed
Correct answer: Be open and honest with the patient and family, acknowledge what happened, offer an apology, provide information about any investigation, and explain what steps are taken to prevent recurrence
Duty of Candour (statutory for NHS organisations under regulation 20 of the Health and Social Care Act 2008, and a professional duty for individual practitioners under GMC Good Medical Practice) requires openness, honesty, and transparency when something goes wrong that causes or may cause harm, including a meaningful apology.
Question 2: According to the GMC's Good Medical Practice, what are the four domains of Good Medical Practice?
- Clinical competence, communication, ethics, and research
- Knowledge, skills, and performance; safety and quality; communication, partnership, and teamwork; maintaining trust (Correct answer)
- Clinical expertise, professionalism, leadership, and education
- Patient care, self-care, team care, and organisational care
Correct answer: Knowledge, skills, and performance; safety and quality; communication, partnership, and teamwork; maintaining trust
GMC Good Medical Practice is organised around four domains: (1) Knowledge, skills, and performance; (2) Safety and quality; (3) Communication, partnership, and teamwork; (4) Maintaining trust. All registered doctors must meet the standards in all four domains.
Question 3: A 14-year-old discloses during a consultation that she is being physically abused by a parent. She asks you to keep it confidential. What should you do?
- Maintain confidentiality as promised
- Explain that you cannot guarantee confidentiality in child protection matters, and refer to the child safeguarding team — child protection takes priority over patient confidentiality (Correct answer)
- Document it but take no further action
- Tell the parents immediately
Correct answer: Explain that you cannot guarantee confidentiality in child protection matters, and refer to the child safeguarding team — child protection takes priority over patient confidentiality
Child safeguarding must take priority over patient confidentiality. NICE, GMC, and Working Together to Safeguard Children guidance require healthcare professionals to refer safeguarding concerns. Confidentiality can be breached when there is serious risk of harm to a child. You should explain to the child what you must do and why.
Question 4: A foundation year doctor prescribes a medication and realises they have made an error that has not yet reached the patient. What should they do?
- Cancel the prescription quietly and say nothing
- Report the error through the hospital incident reporting system, inform the supervising consultant, document the near-miss, and take steps to prevent recurrence (Correct answer)
- Ask a colleague to take over care to distance themselves from the error
- Await the patient's discharge before reporting
Correct answer: Report the error through the hospital incident reporting system, inform the supervising consultant, document the near-miss, and take steps to prevent recurrence
Near misses and errors should be reported through the hospital incident reporting system (e.g., Datix). The supervising consultant must be informed. Near-miss reporting is a key patient safety mechanism that allows system improvements. GMC guidance requires openness and honesty about errors.
Question 5: Which of the following best describes the GMC's guidance on social media use for doctors?
- Doctors should not use any social media
- Doctors must maintain professional standards, protect patient confidentiality, clearly identify themselves as doctors where relevant, and not post anything that could bring the profession into disrepute (Correct answer)
- All social media posts about medicine must be peer-reviewed
- Doctors can share anonymised case details on social media without restriction
Correct answer: Doctors must maintain professional standards, protect patient confidentiality, clearly identify themselves as doctors where relevant, and not post anything that could bring the profession into disrepute
GMC guidance on social media: maintain professional boundaries, protect patient confidentiality (even with apparent anonymisation), treat people with respect, do not make misleading statements about treatments, and maintain standards regardless of the platform. Even personal accounts reflect on the profession.
Question 6: A patient asks you to provide them with a medical certificate stating they are unfit for work for a month when you believe they are fit for work in two weeks. What should you do?
- Provide the certificate as the patient is the expert on their own health
- Decline to certify a longer period than clinically justified — issuing a dishonest certificate is professional misconduct and may constitute fraud (Correct answer)
- Compromise and issue a 3-week certificate
- Refer to a colleague to avoid conflict
Correct answer: Decline to certify a longer period than clinically justified — issuing a dishonest certificate is professional misconduct and may constitute fraud
GMC Good Medical Practice requires honesty and integrity in all aspects of medical practice, including documentation and certification. Issuing an inaccurate medical certificate is dishonest, potentially fraudulent, and constitutes serious professional misconduct. You must only certify what you genuinely believe to be clinically justified.
PLAB 1 NHS Protocols & Professional Practice
A patient under your care develops a serious unexpected complication after surgery that may have been caused by a system failure.
What is the most appropriate action under NHS duty of candour?