PLAB 2 Communication Skills 2 — Questions and Answers
Question 1: In a PLAB 2 station, a patient asks 'Am I going to die, doctor?' after being diagnosed with advanced cancer. What is the most appropriate response?
- Change the subject to avoid distressing the patient
- Acknowledge the question with empathy, explore what prompted it, give honest information at the patient's pace about prognosis, and ensure support is in place (Correct answer)
- Give a precise life expectancy in weeks
- Say 'I don't know' and end the conversation
Correct answer: Acknowledge the question with empathy, explore what prompted it, give honest information at the patient's pace about prognosis, and ensure support is in place
This requires a compassionate, honest response. Acknowledge the question ('That's a really important question'), explore the patient's concerns and understanding, provide honest but sensitive prognostic information, avoid false reassurance, and ensure emotional and practical support. Never give exact timeframes as they are unreliable.
Question 2: A patient's husband calls the ward and asks for an update on his wife's condition. She has not given consent for information to be shared. What should you do?
- Provide a full update as he is her husband
- Explain that you cannot share medical information without the patient's consent, and suggest he visit or ask his wife to give consent for information sharing (Correct answer)
- Refuse to speak to him and hang up
- Share limited information that you think is not too sensitive
Correct answer: Explain that you cannot share medical information without the patient's consent, and suggest he visit or ask his wife to give consent for information sharing
Patient confidentiality applies regardless of the caller's relationship. Unless the patient has given explicit consent, you cannot share clinical information — even with a spouse. You should politely explain this, suggest the husband visits or calls back, and offer to ask the patient about information sharing.
Question 3: During a PLAB 2 station on discharge planning, a patient with newly diagnosed diabetes asks about their condition. Which communication technique is most effective for ensuring the patient understands?
- Use complex medical terminology to demonstrate your expertise
- Use plain language, chunk information into manageable portions, check understanding at each stage using teach-back technique, and provide written information to take home (Correct answer)
- Give all information at once in a single long explanation
- Only provide written leaflets without verbal explanation
Correct answer: Use plain language, chunk information into manageable portions, check understanding at each stage using teach-back technique, and provide written information to take home
Effective patient education uses plain language, breaks information into small chunks, uses the teach-back technique ('Can you tell me in your own words...'), and supplements verbal explanation with written materials. This approach improves understanding, adherence, and health outcomes.
Question 4: A colleague confides in you that they have been drinking alcohol before coming to work. What is your professional obligation according to GMC guidance?
- Keep it confidential as they are your friend
- You have a duty to raise concerns about patient safety — discuss it with your colleague first, then escalate to a senior clinician or through the appropriate reporting channels if the issue is not addressed (Correct answer)
- Ignore it as it is not your responsibility
- Post about it on social media to warn others
Correct answer: You have a duty to raise concerns about patient safety — discuss it with your colleague first, then escalate to a senior clinician or through the appropriate reporting channels if the issue is not addressed
GMC guidance requires all doctors to raise concerns about patient safety. You should speak to your colleague first, encourage them to seek help, and if the concern is not addressed, escalate to a senior colleague, clinical director, or through formal channels. Patient safety takes priority over personal loyalty.
Question 5: In a PLAB 2 station, you need to explain to a patient why you are recommending a medication change. The patient says they don't want to change because the current medication 'has always worked.' What approach demonstrates shared decision-making?
- Tell the patient they must change medication because you are the doctor
- Acknowledge their concern, explain the reasons for the change with evidence, discuss the risks and benefits of both options, and reach a joint decision that respects the patient's preferences and values (Correct answer)
- Change the medication without telling the patient
- Accept the patient's refusal without providing any clinical information
Correct answer: Acknowledge their concern, explain the reasons for the change with evidence, discuss the risks and benefits of both options, and reach a joint decision that respects the patient's preferences and values
Shared decision-making — a core principle of GMC Good Medical Practice — involves providing clear information about options, risks, and benefits, acknowledging the patient's preferences and values, and reaching a collaborative decision. Neither paternalistic nor purely patient-led — it is a partnership.
Question 6: A 15-year-old girl attends alone and requests contraception. She does not want her parents to know. Under Gillick competence, what must you assess?
- You must refuse and insist on parental involvement
- Whether she has sufficient understanding and intelligence to fully comprehend the nature and consequences of the proposed treatment — if Gillick competent, she can consent independently (Correct answer)
- You must report this to social services automatically
- You should prescribe without any assessment
Correct answer: Whether she has sufficient understanding and intelligence to fully comprehend the nature and consequences of the proposed treatment — if Gillick competent, she can consent independently
Under Gillick competence (and Fraser guidelines for contraception), a child under 16 can consent to treatment if they have sufficient maturity and understanding. For contraception specifically, the Fraser guidelines apply: the young person understands the advice, cannot be persuaded to inform parents, their health would suffer without treatment, and it is in their best interest.
PLAB 2 Communication Skills 2
In a PLAB 2 station, a patient asks 'Am I going to die, doctor?' after being diagnosed with advanced cancer.
What is the most appropriate response?