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

Updated: Jul 6


Summary:

This scenario involves discussing a lung cancer diagnosis with the daughter of a patient who had recurrent chest infections and delayed diagnosis. The focus is on explanation, addressing concerns about delay, risk factors, management plan, and communication with empathy.



Key Points:


History & Data Gathering

  • Presenting complaint clarification

    • Onset, duration, and progression of cough

    • Associated symptoms: shortness of breath, hemoptysis, chest pain

    • Systemic symptoms: fatigue, unexplained weight loss, night sweats, appetite loss

  • Medical history

    • Past medical conditions (e.g. COPD)

    • Smoking history (risk factor discussion)

    • Frequency of GP visits, recurrent infections, antibiotics prescribed

  • Impact assessment

    • Effect on daily activities and overall health


Diagnosis Discussion

  • Explain diagnosis in simple terms

    • Clarify how the diagnosis was made: investigations done during admission (e.g. chest X-ray, CT, biopsy)

  • Risk factors

    • Heavy smoking and COPD as known risk factors, not direct causation

  • Delay in diagnosis

    • Possible contributory factors: non-specific presentation, overlapping infection symptoms, clinical judgment based on presentation pattern


Management

  • Immediate steps

    • Oncology team involvement for staging and treatment planning

    • Multidisciplinary team input

  • Supportive care

    • Macmillan Cancer Support, leaflets, smoking cessation resources

    • Psychological counselling referrals for patient and family

  • Follow up

    • Safety netting

    • Scheduling follow-up appointments

    • Encouraging formal complaint if family wishes (PALs)

    • Incident reporting to address concerns


Important Considerations:

  • Start closing and summarising as soon as the 2-minute bell rings

  • Integrate leaflets, follow-up, and support group information in management

  • Address concerns about delayed diagnosis empathetically and factually

  • Clarify antibiotics do not cause cancer

  • Validate emotions: acknowledge daughter’s anger and frustration


Diagnostic Approach:

  1. Review presenting symptoms timeline

  2. Elicit red flag symptoms (hemoptysis, weight loss)

  3. Assess risk factors (smoking, COPD)

  4. Review GP and hospital visit history

  5. Explain investigations performed (X-ray, CT, biopsy)


Management:

  1. Explain diagnosis and risk factors clearly

  2. Emphasise oncology referral and staging process

  3. Offer smoking cessation support

  4. Provide Macmillan or cancer support resources

  5. Acknowledge and discuss daughter’s concerns over delay

  6. Offer counselling and psychological support

  7. Ensure proper documentation and incident reporting

  8. Safety net for deterioration and arrange follow-up


Communication Skills:

  • Use clear, jargon-free language

  • Empathise with family’s concerns

  • Avoid over-rehearsed stock phrases

  • Validate emotions, show active listening

  • Check for understanding throughout

  • Be honest about uncertainty regarding cause of cancer


Ethical Considerations:

  • Duty of candour: openness about delays while avoiding blame

  • Patient autonomy and dignity in management decisions

  • Offering support resources while respecting family decisions

  • Ensuring thorough documentation for team communication


Additional Resources:

  • Macmillan Cancer Support Guidelines

  • GMC Good Medical Practice – Communication & Breaking Bad News

  • NICE Lung Cancer: Diagnosis and Management (NG122)

  • GMC PLAB 2 Examiner Top Tips

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