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Angry Relative Stations: Handling Missed Lung Cancer Diagnoses:: A PLAB 2 Mock- 1st Attempt

Updated: Jul 4

Summary:

This scenario involves addressing the concerns of an angry relative whose elderly mother, a smoker with COPD, was repeatedly treated for chest infections before being diagnosed with lung cancer. The task focuses on empathetic communication, misconception correction, explanation of delays, and outlining next management steps while maintaining professionalism.



Key Points:


Main topic/system involved: Communication with Angry Relatives

  • This is an intimidating station where anger is present from the start.

  • Key task: Identify, address, and validate concerns while managing emotions professionally.

  • Determine the expectations, ideas, concerns of the relative early.

  • Avoid reacting defensively; separate emotion from information to plan management logically.


Clinical System: Respiratory / Oncology

  • Patient: Elderly woman with COPD and smoking history, recurrent chest infections over 4 months, now diagnosed with lung cancer.

  • Relative’s misconception: Believes repeated antibiotics caused cancer; must be corrected factually.


History Gathering Focus:

  • Symptoms of lung cancer:

    • Frequency, duration, progression of cough, SOB, fever

    • Chest pain, hemoptysis, wheeze

    • Constitutional symptoms: weight loss, fatigue, night sweats, appetite loss

  • Risk factors:

    • Smoking, COPD, recurrent infections

  • Paraneoplastic syndromes:

    • Muscle weakness, confusion, unusual pains, hypercalcemia signs.


Management Planning:

  • Clarify that antibiotics do not cause cancer; lung cancer is linked to smoking and environmental exposures.

  • Explain reason for diagnostic delay:

    • Symptoms mimic infections; however, a cancer workup is necessary in elderly with risk factors.

  • Outline next steps:

    • Oncology team involved

    • Further investigations for staging and treatment planning

  • Encourage filing a formal complaint with PALS for investigation if desired.

  • Safety netting:

    • Advise to seek immediate help if patient’s breathlessness worsens or sudden confusion occurs.

  • Offer Macmillan cancer support services and written information.


Important Considerations:

  • Always validate emotions and apologize for distress caused by delays.

  • Do not promise punishment for involved GPs; redirect to PALS.

  • Focus questions to gather management-relevant information within time limits.

  • Use simple language avoiding jargon; ensure understanding by summarising.

  • Do not over-promise referrals outside the realistic scope of immediate management.


Diagnostic Approach:

  1. Identify concerns and emotional state.

  2. Gather focused cancer symptom history.

  3. Explore risk factors and medical history.

  4. Check for paraneoplastic manifestations.

  5. Understand daughter’s ICE (Ideas, Concerns, Expectations).

  6. Formulate differential: lung cancer vs. recurrent pneumonia exacerbated by COPD.

  7. Plan management pathway with clear explanation.


Management:

  • Acknowledge anger and distress empathetically.

  • Correct misconceptions about antibiotics causing cancer.

  • Explain the current diagnosis and reason for delay factually.

  • Arrange for oncology referral and staging investigations.

  • Discuss support options including Macmillan nurses.

  • Document the discussion and inform seniors immediately.

  • Offer formal complaint pathways if dissatisfaction remains.


Communication Skills:

  • Start with addressing emotion directly: “I can see you’re very upset, could you explain why you’re feeling this way?”

  • Maintain calm tone, avoid defensiveness, acknowledge distress.

  • Use active listening, summarise concerns back to the relative.

  • Avoid using stock phrases repeatedly; communicate naturally.

  • Ensure daughter feels involved and supported throughout the discussion.


Ethical Considerations:

  • Maintain professionalism and honesty when explaining delays.

  • Ensure the patient’s dignity and respect are preserved while discussing missed diagnoses.

  • Do not blame other professionals directly; use appropriate channels (PALS).

  • Uphold Good Medical Practice guidelines by being open and apologising if things went wrong.


Additional Resources:

  • GMC Good Medical Practice Communication guidelines

  • NICE guidelines for suspected lung cancer referral

  • Macmillan Cancer Support resources for patients and families

  • GMC Examiner Top Tips for PLAB 2 communication stations

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