PLAB 2 Professional Ethics & Safeguarding — Questions and Answers
Question 1: During an OSCE station, you discover that a colleague has been consistently arriving drunk to work. What is your professional obligation?
- It is not your responsibility — ignore it
- You have a duty to report your concerns to a senior colleague, clinical supervisor, or responsible officer — patient safety takes precedence. The GMC guidance 'Raising and Acting on Concerns' requires action when patients may be at risk (Correct answer)
- Directly confront the colleague in public
- Write an anonymous letter to the GMC immediately without speaking to the colleague first
Correct answer: You have a duty to report your concerns to a senior colleague, clinical supervisor, or responsible officer — patient safety takes precedence. The GMC guidance 'Raising and Acting on Concerns' requires action when patients may be at risk
GMC guidance 'Raising and Acting on Concerns about Patient Safety' requires that doctors take action if they believe patients are at risk from a colleague's health, performance, or conduct. This should be raised with an appropriate person (clinical supervisor, medical director, or responsible officer). The colleague may also need occupational health support.
Question 2: A 10-year-old boy attends A&E with a bruise on his back. His mother explains he fell down stairs. On examination you notice multiple old bruises in various stages of healing and a pattern inconsistent with accidental injury. What is the most appropriate action?
- Accept the explanation and discharge
- Maintain a high index of suspicion for non-accidental injury; admit the child for safeguarding assessment; consult the paediatric safeguarding team; do not discharge without specialist review; document all findings accurately (Correct answer)
- Call the police immediately and accuse the mother
- Discuss with the mother only and seek her consent before involving safeguarding teams
Correct answer: Maintain a high index of suspicion for non-accidental injury; admit the child for safeguarding assessment; consult the paediatric safeguarding team; do not discharge without specialist review; document all findings accurately
Multiple bruises in various stages of healing, a pattern inconsistent with the stated mechanism, and the specific location (back — not a typical accidental injury site) are all indicators of possible non-accidental injury (NAI). The child should not be discharged. Safeguarding referral is mandatory. Section 47 enquiries may be triggered. You do not need parental consent to make a safeguarding referral.
Question 3: A patient in your clinic discloses she is experiencing domestic violence from her partner. She does not want anyone to know. What is the most appropriate response?
- Report to police immediately without her consent
- Provide immediate safety information, document sensitively, offer referral to domestic violence support services, consider safeguarding risk (especially if children are involved or severe risk to life), and respect her autonomy while maintaining regular review (Correct answer)
- Dismiss the disclosure as it is not a medical matter
- Ask her partner to come in for a joint consultation
Correct answer: Provide immediate safety information, document sensitively, offer referral to domestic violence support services, consider safeguarding risk (especially if children are involved or severe risk to life), and respect her autonomy while maintaining regular review
Domestic violence requires a sensitive, non-judgmental, empowering response. Give immediate safety information (National DV helpline), document carefully (may be needed later), offer specialist referral (IDVA, shelter), but respect her autonomy in deciding what to do. However, if there is a serious and imminent risk to her life or a child's safety, confidentiality may need to be breached.
Question 4: A medical student asks you to allow them to perform a vaginal examination on a patient under anaesthesia who had not specifically consented to this. What should you do?
- Allow it as it is common practice in teaching hospitals
- Refuse — intimate examinations under anaesthesia require specific consent. Performing any examination without appropriate consent constitutes battery, regardless of educational benefit (Correct answer)
- Allow it only if a consultant is present
- Allow it but document it as a routine procedure
Correct answer: Refuse — intimate examinations under anaesthesia require specific consent. Performing any examination without appropriate consent constitutes battery, regardless of educational benefit
Any examination — including intimate examinations under anaesthesia — requires prior informed consent. Performing a vaginal examination without the patient's specific consent is a serious breach of consent and dignity, constituting a criminal offence (battery) and a disciplinary matter. GMC guidance is explicit: intimate examinations require specific consent regardless of setting.
Question 5: During a PLAB 2 OSCE station, you are asked to take a history from a patient through an interpreter. What communication principles should you follow?
- Speak to the interpreter and let them manage the conversation
- Speak directly to the patient (not the interpreter), use short sentences, pause frequently, avoid medical jargon, use professional interpreters rather than family members, and check understanding regularly (Correct answer)
- Use written communication only
- Speak loudly and slowly to the patient without a professional interpreter
Correct answer: Speak directly to the patient (not the interpreter), use short sentences, pause frequently, avoid medical jargon, use professional interpreters rather than family members, and check understanding regularly
When using an interpreter: speak directly to the patient, maintaining eye contact with them not the interpreter; use short sentences; pause frequently for accurate interpretation; avoid jargon; use a professional interpreter (not family members who may filter, add, or omit information); check understanding with the patient directly; document that an interpreter was used.
Question 6: A frail 85-year-old patient is brought to hospital by her son who mentions he has Power of Attorney. He asks that his mother not be told about her cancer diagnosis 'as it would upset her'. What should you do?
- Follow the son's wishes — he has legal authority
- Assess the patient's capacity; if she has capacity, she has the right to receive information about her own health. An LPA for health and welfare does not allow the attorney to prevent disclosure of a diagnosis to a patient with capacity. If she lacks capacity, best interests still usually supports honesty (Correct answer)
- Avoid telling the patient to avoid conflict with the family
- Document the son's request and discharge the patient without discussion
Correct answer: Assess the patient's capacity; if she has capacity, she has the right to receive information about her own health. An LPA for health and welfare does not allow the attorney to prevent disclosure of a diagnosis to a patient with capacity. If she lacks capacity, best interests still usually supports honesty
Having a Power of Attorney does not allow an attorney to withhold information from a patient who has capacity — doing so would be a breach of the patient's rights. A person with capacity has the right to information about their own health. If the patient lacks capacity, you must still consider whether knowing would be in their best interests (often it is). Collusion with family to withhold a diagnosis from a capacitous patient is not acceptable.
