PLAB 1 NHS Protocols & Professional Practice 2

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?

Accepted Answer

Decline to perform the procedure, explain your competence limits, seek urgent senior/on-call specialist help, and inform the patient of the delay

Answer

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?

Accepted 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

Answer

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?

Accepted 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)

Answer

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?

Accepted 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

Answer

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?

Accepted 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

Answer

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.

PLAB 1 Practice Test

PLAB 1 Practice Test

PLAB 1 NHS Protocols & Professional Practice 2