Compassionate Abortion Counseling, A Guide to Risk, Reassurance & Respectful Communication: A PLAB 2 Mock Scenario

Practice a case with the AI patient 🤖

Summary:

This station involves a 25-year-old woman seeking information and reassurance before a scheduled surgical abortion. The candidate must address her concerns regarding fertility, explain the procedure, its risks, and provide emotional support in a sensitive, patient-centered manner.

Key Points:

Patient Presentation:

• 25-year-old woman, Emily, 12 weeks pregnant

• First pregnancy, unplanned

• Scheduled for surgical abortion, anxious about risks, especially related to fertility

History Taking:

• Thorough obstetric and medical history taken

• No current medical issues, medications, or allergies

• Ultrasound confirmed gestational age

• Lifestyle habits discussed (occasional alcohol, no smoking)

Concerns Raised:

• Future fertility

• Surgical risks and complications

• Misunderstanding about what the placenta is

Important Considerations:

• Confirm full patient identity (e.g., full name and age) to maintain confidentiality

• Avoid using stock phrases or over-signposting (e.g., "May I ask you a personal question?")

• Use patient-friendly language, but avoid over-simplifying anatomical terms (e.g., calling the placenta "the womb")

• Understand and correct misconceptions empathetically

Diagnostic Approach:

• Confirm gestational age via scan (already done)

• Rule out current complications (bleeding, nausea, pain)

• General examination (vitals, abdominal exam)

• Assess understanding of procedure and risks

Management:

Procedure Explanation:

• Surgical abortion typically offered between 10–24 weeks

• Done under local or general anesthesia

• Usually involves cervical dilatation and evacuation

Risks:

• Generally safe, but potential complications include:

  • Uterine perforation

  • Infections (e.g., endometritis, PID)

  • Retained products of conception

  • Cervical trauma

  • Asherman’s syndrome (rare)

• Risk minimization:

  • Antibiotic prophylaxis (e.g., doxycycline, metronidazole)

  • Sterile surgical technique

Fertility Reassurance:

• Procedure itself does not cause infertility

• Complications can, but are rare with proper precautions

Follow-up and Safety Netting:

• Warn about signs of infection or retained products (pain, fever, bleeding)

• Provide written information and arrange follow-up

Communication Skills:

• Explore ICE: Ideas, Concerns, Expectations

• Use clear, empathetic, and reassuring language

• Avoid medical jargon and confirm patient understanding

• Offer contraception counseling post-procedure

• Involve the patient in shared decision-making

Ethical Considerations:

• 
  

• Respect for patient autonomy and informed choice

• Confidentiality and sensitivity in communication

• Non-judgmental attitude towards patient decisions

• Provision of balanced and factual information without coercion

Additional Resources:

• GMC: Good Medical Practice

• NHS Abortion Care Guidelines

• Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Guidance

• RCOG: Abortion Care Guidelines