PLAB 2 Mock Test Feedback :: Delayed Diagnosis :: Angry Patient :: Attempt 1

Mock Date: 02/07/2025
1st Attempt
Topic: Angry Patient
Case Name: Delayed Diagnosis
Action Items:
Practice and Review the case in the OSCE workbench:	Click Here
Watch the (Private) Mock Test Video Recording:	Click Here
Read the Case Blog:	Click Here
Additional Resources:	Click Here
Deep Dive into your (Private) performance below:
Scenario Summary:
You are an FY2 doctor in the respiratory unit. Your patient, Hilary Tate, a 70-year-old woman with a history of COPD and heavy smoking, was admitted two days ago with a cough and has been diagnosed with lung cancer. You need to address the concerns of her daughter, Natalie Tate, who is upset and wants to know why her mother's lung cancer was not diagnosed earlier.
My Performance:
🔍Let’s Deep Dive into your performance:
The Domain-wise evaluation shows areas where you did well and others where you have room to grow.
A "Yes" means you covered that point effectively
A "Partial" indicates that you did some of it well but missed some key details.
A "No" means there was an important opportunity that wasn’t addressed.
Don’t worry if you see several areas marked "No" or "Partial"—this is common and simply highlights where you can focus your learning.
By reflecting on these areas and practising, you’ll be able to improve and feel more confident in your consultations. Remember, every bit of feedback is an opportunity to grow, and you’re on the right path by taking these steps.
Timestamps are provided to show exactly when during the consultation you covered or missed key points. Reviewing these can help you see how well you're managing your time and where you might need to be more efficient in addressing important areas.

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Patient identifiers: Confirm patient's name (Hilary Tate) and age (70 years old)	00:39, 00:43	yes	You confirmed both name and age early, which was good. Keep this consistent in all stations.
Data Gathering	Confirm the daughter’s name and relationship to the patient.	00:15, 00:35	yes	You confirmed Natalie’s name and that she is the daughter effectively.
Data Gathering	Clarify the purpose of today’s conversation and the daughter’s main concerns.	1:01	partial	You understood her concern about delayed diagnosis but did not clearly summarise or signpost the purpose of the conversation at the start. Next time, say “I understand you’re worried about the diagnosis delay. Let’s go through what happened and what we can do today.”
Data Gathering	Ask about the onset, duration, and progression of the mother’s cough.	2:20	partial	You asked about her cough worsening but missed details of exact onset and progression over time. Next time, ask “When did her cough start? Has it gradually worsened or suddenly become severe?”
Data Gathering	Ask about shortness of breath – when it started, if it has worsened, and any triggers, ask about presence of haemoptysis (coughing blood), ask about chest pain – site, onset, character, radiation, exacerbating or relieving factors.		no	You missed asking about shortness of breath details, haemoptysis, and chest pain completely. Next time, systematically ask: “Has she been short of breath? Any chest pain or blood in her sputum?”
Data Gathering	Ask about paraneoplastic symptoms such as muscle weakness, confusion, or unusual pains.		no	This was missed. Next time, add: “Any new weakness, confusion, or unusual pains recently?” to screen for paraneoplastic syndromes.
Data Gathering	Inquire about the frequency and duration of GP visits and treatments received	3:02	partial	You asked about previous admissions and antibiotics but did not quantify GP visit frequency. Next time, ask directly “How often have you been visiting the GP for these issues?”
Data Gathering	Assess the impact of symptoms on daily activities and overall health	4:29	yes	You asked about daily management and her mood and sleep patterns, which was good.
Data Gathering	Ask about systemic symptoms like fatigue, unexplained weight loss, night sweats, and loss of appetite.	3:57	partial	You asked about appetite and weight but missed fatigue and night sweats. Next time, ask “Has she felt unusually tired or had night sweats recently?”
Data Gathering	Current medications: Inhalers for COPD, any other medications?		no	You asked about antibiotics but missed asking about her inhalers or other medications. Next time, add “Is she on any inhalers for her COPD or other regular medications?”
Data Gathering	Past medical history: Confirm history of COPD, any other significant conditions	5:35	partial	You confirmed COPD but did not ask about any other significant past conditions. Next time, add “Does she have any other medical conditions apart from COPD?”
Data Gathering	Smoking history: Confirm 40 cigarettes a day for over 50 years	5:35	yes	You confirmed this clearly.
Data Gathering	ICE (Ideas, Concerns, and Expectations): Understand daughter's concerns about delayed diagnosis and expectations for the consultation	01:19, 01:37	partial	You explored her concern about delay but did not explore her expectations. Next time, ask directly “What would you like us to achieve today?”
Management	Validate emotions: Acknowledge and empathize with the daughter's feelings of anger and frustration	01:44, 03:33	yes	You acknowledged her frustration multiple times appropriately.
Management	Explain her mother’s current diagnosis in simple language – lung cancer confirmed after recent CT scan.	5:29	partial	You mentioned lung cancer diagnosis linked with smoking and COPD but did not clearly state “Your mother has been diagnosed with lung cancer after a CT scan.” Next time, state it simply and clearly before elaborating.
Management	Explain that COPD and heavy smoking are significant risk factors for lung cancer.	5:45	yes	You explained this clearly.
Management	Discuss the possible reasons for delayed diagnosis: Symptoms mimicking common conditions like chest infections		no	You did not discuss how symptoms can mimic chest infections causing diagnostic delays. Next time, say “Her symptoms can look like chest infections which often delays diagnosis.”
Management	Clarify that antibiotics do not cause lung cancer, addressing her specific worry.		no	She asked if antibiotics caused cancer but you missed clarifying this. Next time, say “Antibiotics do not cause cancer, they were given to treat presumed infections.”
Management	Explain next steps: oncology team involvement and further staging investigations.		no	You did not explain next steps like oncology referral or staging. Next time, add “The oncology team will plan further scans to stage her cancer and discuss treatment options.”
Management	Ensure appropriate care: Under the care of the oncology team, provide necessary support and treatment		no	You did not mention oncology team taking over care formally. Next time, reassure “She is under oncology team care who will guide her treatment.”
Management	Address specific concerns: Encourage filing a formal complaint with PALS for thorough investigation	6:24	yes	You offered PALS appropriately.
Management	Inform her you will fill out an incident report to ensure her concerns are addressed systematically.		no	You did not mention filling an incident report. Next time, say “I will also fill out an incident report so the team can review what happened thoroughly.”
Management	Document the conversation thoroughly in the patient’s notes for team communication and informing the seniors		no	You did not mention documentation. Next time, say “I will document our discussion for the team to be aware and follow up appropriately.”
Management	Reassure: Ensure the daughter that her mother will receive the best care possible moving forward	7:06	partial	You partially reassured but did not clearly state she will receive best possible care. Next time, say “We will ensure she gets the best care moving forward.”
Management	Follow-Up: Schedule a meeting at the end of the day to review progress and discuss new information. Offer to arrange for her to speak with a senior doctor or consultant if desired.		no	You missed offering follow-up meetings or senior doctor discussion. Next time, say “I can arrange for you to speak to our consultant today if you wish, and we can review things again later today.”
Management	Safety net: Advise her to contact the ward immediately if her mother’s breathing worsens, she becomes confused, or any sudden changes occur.		no	You did not safety net. Always end by saying “Please contact us immediately if her breathing worsens or she becomes confused or unwell.”
Management	Offer her information leaflets about lung cancer and available support services.		no	You missed offering information leaflets. Next time, say “Would you like some written information about lung cancer and support services?”
Management	Offer counselling services to support the family emotionally through this diagnosis.		no	You missed offering counselling. Next time, say “We can also arrange counselling support for you and your family if you feel it would help.”
Interpersonal Skills	Express support: Acknowledge the daughter's emotions and provide comfort	3:33	yes	You did this well with understanding statements.
Interpersonal Skills	Express empathy by stating you are sorry for what her family is going through.	6:24	yes	You apologised for what they are going through clearly.
Interpersonal Skills	Use simple language: Explain medical terms and diagnosis in layman's terms	5:29	partial	You partially explained diagnosis but used medical phrasing like “risk factors” without simple breakdown. Next time, simplify: “Her long-term smoking and lung disease damaged her lungs and caused cancer cells to grow.”
Interpersonal Skills	Check understanding: Ensure the daughter comprehends the discussion, invite questions		no	You did not check understanding or invite questions. Next time, ask “Is there anything I said that you’d like me to clarify?”
Interpersonal Skills	Patient-centered approach: Involve the daughter in the discussion about next steps and care plan		no	You did not involve her in planning next steps. Next time, ask “What would you like us to focus on for her care at this stage?”
Interpersonal Skills	Active listening: Encourage the daughter to express her concerns and feelings	1:19	yes	You asked her to share concerns effectively.
Interpersonal Skills	Reassure: Offer hope and support for the future care of the patient		no	You did not offer hope about supportive care and symptom relief. Next time, say “We will focus on keeping her comfortable and supported moving forward.”

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation. Includes illogical and disordered approach to questioning. You did not demonstrate sufficiently the ability to follow a logical structure in your consultation. For example, your history taking may have appeared disjointed, with your line of questioning erratic and not following reasoned thinking. You may have undertaken practical tasks or examination in an illogical order that suggested you did not have a full grasp of the reason for completing them or a plan for the consultation.	✔️
Diagnosis	Does not make the correct working diagnosis or identify an appropriate range of differential possibilities.
Examination	Does not undertake physical examination competently, or use instruments proficiently.
Findings	Does not identify abnormal findings or results or fails to recognise their implications. You did not identify or recognise significant findings in the history, examination or data interpretation.
Issues	Does not recognise the issues or priorities in the consultation (for example, the patient’s key problem or the immediate management of an acutely ill patient). You did not recognise the key element of importance in the station. For example, giving health and lifestyle advice to an acutely ill patient.	✔️
Management	Does not develop a management plan reflecting current best practice, including follow up and safety netting.	✔️
Rapport	Does not appear to develop rapport or show sensitivity for the patient’s feelings and concerns, including use of stock phrases. You did not demonstrate sufficiently the ability to conduct a patient centred consultation. Perhaps you did not show appropriate empathy or sympathy, or understanding of the patient’s concerns. You may have used stock phrases that show that you were not sensitive to the patient as an individual, or failed to seek agreement to your management plan.	✔️
Listening	Does not make adequate use of verbal & non-verbal cues. Poor active listening skills. You did not demonstrate sufficiently that you were paying full attention to the patient’s agenda, beliefs and preferences. For example, you may have asked a series of questions but not listened to the answers and acted on them.
Language	Does not use language or explanations that are relevant and understandable to the patient, including not checking understanding. The examiner may have felt, for example, that you used medical jargon, or spoke too quickly for the patient to take in what you were saying.
Time	Shows poor time management. You showed poor time management, probably taking too long over some elements of the encounter at the expense of other, perhaps more important areas.	✔️

Data_gathering	Management	IPS
2	1	2