PLAB 1 NHS Protocols & Professional Practice 2 — Questions and Answers
Question 1: A junior doctor on night shift is the only available doctor for the ward. They are asked to perform a procedure they have not been trained to do and feel unsafe. What is the most appropriate action?
- Attempt the procedure — patient need comes first
- Decline to perform the procedure, explain your competence limits, seek urgent senior/on-call specialist help, and inform the patient of the delay (Correct answer)
- Perform the procedure with a nurse supervising
- Document that the procedure was refused and leave for morning team
Correct answer: Decline to perform the procedure, explain your competence limits, seek urgent senior/on-call specialist help, and inform the patient of the delay
GMC Good Medical Practice: you must recognise and work within your competence. Attempting procedures beyond your competence puts patients at risk. You must ask for help from a competent colleague urgently. Patient safety requires honesty about limitations, not false heroism.
Question 2: What is the purpose of a 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) order and how should it be made?
- A form completed by the family to refuse resuscitation for their relative
- A clinical decision that CPR would not be clinically appropriate or not in the patient's best interests, made through discussion with the patient (and family where appropriate) and senior clinician, documented clearly (Correct answer)
- A form completed by junior doctors after admission for all elderly patients
- An administrative decision made by hospital managers to allocate resources
Correct answer: A clinical decision that CPR would not be clinically appropriate or not in the patient's best interests, made through discussion with the patient (and family where appropriate) and senior clinician, documented clearly
DNACPR is a clinical decision, not an administrative one. It requires: clinical assessment that CPR would be futile or not in the patient's best interests; sensitive discussion with the patient (if they have capacity) and appropriate communication with family; documentation and communication across care settings. Families cannot override a competent patient's wishes.
Question 3: Under UK law, when may a doctor breach patient confidentiality without consent?
- Whenever the doctor judges it appropriate
- In specific circumstances: serious risk of harm to the patient or others that outweighs the duty of confidentiality; statutory duty to disclose (e.g., notifiable diseases); court order; or for public interest purposes (e.g., serious crime) (Correct answer)
- Whenever a family member requests medical information
- For any research purpose with ethics approval
Correct answer: In specific circumstances: serious risk of harm to the patient or others that outweighs the duty of confidentiality; statutory duty to disclose (e.g., notifiable diseases); court order; or for public interest purposes (e.g., serious crime)
GMC confidentiality guidance permits breach without consent for: preventing serious crime or risk of serious harm; notifiable diseases; court orders; and specific statutory requirements. The decision to breach must be proportionate, and disclosure should be to an appropriate authority. Always consider whether anonymisation suffices.
Question 4: What is the definition of a 'notifiable disease' in the UK and what are your obligations?
- Any disease that must be disclosed to the patient's family
- Specified infectious diseases that doctors have a statutory duty to notify to the local authority proper officer (usually the local UKHSA health protection team) — failure to notify is an offence (Correct answer)
- Any serious illness requiring hospital admission
- Diseases requiring mandatory treatment under the Mental Health Act
Correct answer: Specified infectious diseases that doctors have a statutory duty to notify to the local authority proper officer (usually the local UKHSA health protection team) — failure to notify is an offence
Under the Health Security (Notification) Regulations 2010, doctors must notify the local authority's proper officer (usually Health Protection Team) of specified notifiable diseases (e.g., TB, measles, meningitis, COVID-19). This statutory obligation exists regardless of patient consent and supports public health surveillance and outbreak management.
Question 5: A patient in A&E who smells of alcohol is being verbally abusive and trying to leave before assessment. He has a head injury. What is the most important consideration?
- Discharge him immediately to avoid conflict
- Carefully assess his capacity — intoxication may impair capacity; if he lacks capacity, he can be detained in his best interests under the MCA; if he has capacity, he has the right to leave but should sign a self-discharge form (Correct answer)
- Call police to detain him
- Physically restrain him regardless of capacity
Correct answer: Carefully assess his capacity — intoxication may impair capacity; if he lacks capacity, he can be detained in his best interests under the MCA; if he has capacity, he has the right to leave but should sign a self-discharge form
Intoxication may impair capacity — the capacity assessment must be made at that time, considering whether he can understand, retain, weigh, and communicate information about his condition and the risks of leaving. If capacity is absent, best interests (MCA) applies and treatment/retention may be justified. If he has capacity, you cannot detain him but must document risks.
Question 6: A patient's relative calls demanding information about the patient's condition. The patient is an adult with capacity and has not given consent to share information with their family. What should you do?
- Provide the information as the relative is clearly concerned
- Decline to confirm or deny any information — confidentiality belongs to the patient and they have not consented to disclosure (Correct answer)
- Provide general information without specific details
- Ask the consultant to decide
Correct answer: Decline to confirm or deny any information — confidentiality belongs to the patient and they have not consented to disclosure
Confidentiality belongs to the patient. An adult patient with capacity must specifically authorise disclosure to third parties, including family. Without that consent, you should not confirm or deny details of their condition or treatment. This applies even to close relatives, unless there is a specific lawful basis for disclosure.
PLAB 1 NHS Protocols & Professional Practice 2
A junior doctor on night shift is the only available doctor for the ward.
They are asked to perform a procedure they have not been trained to do and feel unsafe.
What is the most appropriate action?