PLAB 2 Communication Skills — Questions and Answers
Question 1: In a PLAB 2 communication station, you need to break bad news to a patient about a cancer diagnosis. Which framework should you use?
- Just tell the patient the diagnosis directly without preparation
- The SPIKES framework: Setting, Perception, Invitation, Knowledge, Emotions, Strategy and Summary (Correct answer)
- Write the diagnosis on a piece of paper and hand it to the patient
- Delegate the task to a nurse or counsellor
Correct answer: The SPIKES framework: Setting, Perception, Invitation, Knowledge, Emotions, Strategy and Summary
SPIKES is the validated framework for breaking bad news: Setting (ensure privacy), Perception (assess what the patient knows), Invitation (ask how much they want to know), Knowledge (deliver information clearly using a warning shot), Emotions (acknowledge and respond empathically), Strategy/Summary (discuss next steps).
Question 2: A patient in a PLAB 2 station refuses a blood transfusion on religious grounds (Jehovah's Witness). The transfusion could be life-saving. What is the correct approach?
- Transfuse the patient anyway as it is in their best interest
- Respect the patient's autonomous decision after ensuring they have capacity and understand the consequences, document the refusal, and explore alternative treatments (Correct answer)
- Discharge the patient for non-compliance
- Ask the family to override the patient's decision
Correct answer: Respect the patient's autonomous decision after ensuring they have capacity and understand the consequences, document the refusal, and explore alternative treatments
A competent adult has the right to refuse any treatment, even if refusal may result in death. You must assess capacity (Mental Capacity Act 2005), ensure the patient understands the risks, explore alternatives (e.g., cell salvage, erythropoietin), document the discussion, and respect their decision. Family cannot override a competent patient's wishes.
Question 3: During a PLAB 2 station, an angry patient complains about a long wait in A&E and demands to see a senior doctor. What is the most appropriate response?
- Tell the patient they are being unreasonable and ask them to calm down
- Acknowledge the patient's frustration empathically, apologise for the wait, explain the situation, and address their concerns while maintaining a calm, professional demeanour (Correct answer)
- Ignore the complaint and proceed with the clinical assessment
- Immediately escalate to your consultant without attempting to address the concern yourself
Correct answer: Acknowledge the patient's frustration empathically, apologise for the wait, explain the situation, and address their concerns while maintaining a calm, professional demeanour
Managing angry patients requires empathy, active listening, and de-escalation. Acknowledge their feelings ('I understand you are frustrated'), apologise where appropriate, explain the reasons for the delay, and demonstrate that their concerns matter. Maintaining professionalism is key — do not become defensive.
Question 4: You are explaining a surgical procedure to a patient and obtaining informed consent. According to the Montgomery ruling (2015), what is required?
- Simply getting the patient to sign a consent form is sufficient
- You must discuss all material risks that a reasonable person in the patient's position would want to know about, including alternatives to the procedure (Correct answer)
- You only need to mention risks with >10% probability
- Consent can be obtained by the most junior team member without detailed explanation
Correct answer: You must discuss all material risks that a reasonable person in the patient's position would want to know about, including alternatives to the procedure
The Montgomery v Lanarkshire ruling (2015) established that doctors must inform patients of all material risks — those to which a reasonable person in the patient's position would attach significance. This includes risks specific to that patient. Alternatives must also be discussed. This replaced the previous Bolam test for consent.
Question 5: In a PLAB 2 station, a patient asks you to keep their HIV diagnosis confidential from their sexual partner. What is the correct approach?
- Always maintain complete confidentiality regardless of circumstances
- Encourage the patient to disclose to their partner, explain the importance of partner notification, and consider involving the sexual health team. Disclosure without consent may be justified in exceptional circumstances to protect an identifiable person at serious risk (Correct answer)
- Immediately call the patient's partner yourself
- Refuse to discuss the topic further
Correct answer: Encourage the patient to disclose to their partner, explain the importance of partner notification, and consider involving the sexual health team. Disclosure without consent may be justified in exceptional circumstances to protect an identifiable person at serious risk
GMC guidance states that confidentiality is not absolute. You should encourage voluntary disclosure, offer support through the sexual health team's partner notification service, and explain the legal and ethical position. Disclosure without consent may be justified if there is a serious and identifiable risk to a specific person, but this must involve senior advice.
Question 6: A patient with limited English proficiency presents to your PLAB 2 station. A family member offers to interpret. What is the best approach?
- Accept the family member as interpreter — it saves time
- Use a professional interpreter (face-to-face or telephone) rather than a family member, as family members may filter information, add bias, or be unable to translate medical terminology accurately (Correct answer)
- Speak louder and slower in English
- Postpone the consultation until the patient learns English
Correct answer: Use a professional interpreter (face-to-face or telephone) rather than a family member, as family members may filter information, add bias, or be unable to translate medical terminology accurately
GMC guidance recommends using professional interpreters rather than family members, who may filter, censor, or inaccurately translate information — particularly for sensitive topics (e.g., domestic violence, mental health). Children should never be used as interpreters. Professional services ensure accurate, impartial communication.
PLAB 2 Communication Skills
In a PLAB 2 communication station, you need to break bad news to a patient about a cancer diagnosis.
Which framework should you use?