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

Mock Date: 02/07/2025
2nd 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)		No	You confirmed the patient's name (Hilary) indirectly via her daughter (Natalie) but did not ask her age. Next time, remember to clarify the patient's age to ensure accurate identification and safe documentation. You could have asked this after confirming her name at 1:00:10.
Data Gathering	Confirm the daughter’s name and relationship to the patient.	00:13	Yes	Well done confirming Natalie’s name and her relationship as daughter early on.
Data Gathering	Clarify the purpose of today’s conversation and the daughter’s main concerns.		Partial	You explored concerns about delayed diagnosis and cancer but did not explicitly clarify the purpose of the conversation upfront. Next time, begin with “What would you like to discuss today?” after greetings at 1:00:18 to set an agenda.
Data Gathering	Ask about the onset, duration, and progression of the mother’s cough.	01:34	Yes	Good job asking duration and progression clearly.
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.		Partial	You asked about SOB, haemoptysis, and chest pain generally (1:02:00-1:02:26) but did not explore chest pain in detail (site, character, radiation, triggers). Next time, systematically cover each chest pain element.
Data Gathering	Ask about paraneoplastic symptoms such as muscle weakness, confusion, or unusual pains.		No	You missed asking about muscle weakness, confusion, or unusual pains. You could have incorporated this after systemic symptoms at 1:03:14.
Data Gathering	Inquire about the frequency and duration of GP visits and treatments received		Partial	You discussed repeated admissions and GP antibiotics (1:01:39, 1:05:02) but did not ask frequency/duration of GP visits clearly. Next time ask “How often was she seeing the GP for this?” for clarity.
Data Gathering	Assess the impact of symptoms on daily activities and overall health		Partial	You asked about mood changes (1:03:22) but not specifically how symptoms affected daily activities like walking, dressing, eating. Next time ask, “Has her cough affected her day-to-day activities?”.
Data Gathering	Ask about systemic symptoms like fatigue, unexplained weight loss, night sweats, and loss of appetite.		Partial	You explored weight loss (1:02:14) but missed fatigue, night sweats, and appetite changes. Remember to cover all systemic symptoms when assessing possible cancer.
Data Gathering	Current medications: Inhalers for COPD, any other medications?	03:03	Yes	You covered inhaler type (brown) and other medications (paracetamol). Well done.
Data Gathering	Past medical history: Confirm history of COPD, any other significant conditions	02:43	Yes	You confirmed COPD and ruled out other conditions. Good.
Data Gathering	Smoking history: Confirm 40 cigarettes a day for over 50 years		Partial	You confirmed smoking 40/day (1:04:17) but did not clarify duration in years. Next time, ask “How many years has she been smoking 40 a day?”
Data Gathering	ICE (Ideas, Concerns, and Expectations): Understand daughter's concerns about delayed diagnosis and expectations for the consultation	05:20	Yes	You elicited her concerns about delay and expectations regarding complaints. Well done.
Management	Validate emotions: Acknowledge and empathize with the daughter's feelings of anger and frustration	01:06	Yes	You validated her distress multiple times empathetically. Good job.
Management	Explain her mother’s current diagnosis in simple language – lung cancer confirmed after recent CT scan.		No	You did not explicitly explain lung cancer was confirmed after CT. You mentioned cancer broadly. Next time, state clearly: “The CT scan showed lung cancer.”
Management	Explain that COPD and heavy smoking are significant risk factors for lung cancer.	07:32	Yes	You explained smoking and COPD as risk factors concisely. Good.
Management	Discuss the possible reasons for delayed diagnosis: Symptoms mimicking common conditions like chest infections		No	You did not discuss this clearly. Next time, explain: “Sometimes cancer symptoms can mimic chest infections, which may delay diagnosis.”
Management	Clarify that antibiotics do not cause lung cancer, addressing her specific worry.	05:37	Yes	You addressed this well.
Management	Explain next steps: oncology team involvement and further staging investigations.	07:19	Yes	You explained oncologist involvement and further investigations clearly.
Management	Ensure appropriate care: Under the care of the oncology team, provide necessary support and treatment	07:15	Yes	You reassured about ongoing oncologist care.
Management	Address specific concerns: Encourage filing a formal complaint with PALS for thorough investigation	06:16	Yes	You offered PALS contact and formal complaint process.
Management	Inform her you will fill out an incident report to ensure her concerns are addressed systematically.	07:45	Yes	You stated you would file an incident report. Well done.
Management	Document the conversation thoroughly in the patient’s notes for team communication and informing the seniors		No	You did not mention documenting this conversation. Next time, mention you will update her mother’s notes and inform seniors.
Management	Reassure: Ensure the daughter that her mother will receive the best care possible moving forward	07:07	Yes	You reassured about best care repeatedly. Good.
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 did not arrange follow-up or offer senior discussion. Next time offer: “Would you like to speak with the consultant later today to discuss her care further?”
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 provide safety netting advice. Always close consultations with clear red flag advice.
Management	Offer her information leaflets about lung cancer and available support services.		No	You did not offer leaflets or support service info. Next time say “I can give you some written information about lung cancer and local support groups.”
Management	Offer counselling services to support the family emotionally through this diagnosis.		No	You did not offer counselling support. Next time say, “Would you like me to refer you to our counselling services to support you emotionally at this time?”
Interpersonal Skills	Express support: Acknowledge the daughter's emotions and provide comfort	01:06	Yes	You provided good comfort and support throughout.
Interpersonal Skills	Express empathy by stating you are sorry for what her family is going through.	01:06	Yes	You expressed sorrow sincerely multiple times.
Interpersonal Skills	Use simple language: Explain medical terms and diagnosis in layman's terms		Partial	You used simple language mostly, but cancer explanation was vague. Next time say “Cancer means there are abnormal cells in the lung growing uncontrollably.”
Interpersonal Skills	Check understanding: Ensure the daughter comprehends the discussion, invite questions		Partial	You asked “Do you understand what I explained?” (1:06:41) but did not actively invite questions or check understanding at the end.
Interpersonal Skills	Patient-centered approach: Involve the daughter in the discussion about next steps and care plan		Partial	You explained next steps but did not involve her in decisions. Next time ask, “Is there anything you would like us to prioritise for her care today?”
Interpersonal Skills	Active listening: Encourage the daughter to express her concerns and feelings	05:20	Yes	You encouraged her to speak about her worries. Good.
Interpersonal Skills	Reassure: Offer hope and support for the future care of the patient	07:15	Yes	You reassured her about future care well.

	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
3	2	4