PLAB 2 Communication Skills

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?

Accepted Answer

The SPIKES framework: Setting, Perception, Invitation, Knowledge, Emotions, Strategy and Summary

Answer

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?

Accepted Answer

Respect the patient's autonomous decision after ensuring they have capacity and understand the consequences, document the refusal, and explore alternative treatments

Answer

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?

Accepted Answer

Acknowledge the patient's frustration empathically, apologise for the wait, explain the situation, and address their concerns while maintaining a calm, professional demeanour

Answer

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?

Accepted 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

Answer

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?

Accepted 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

Answer

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.

PLAB 2 Practice Test

PLAB 2 Practice Test

PLAB 2 Communication Skills