PUID: 42 || PLAB 2 Mock 6 :: AngryAfterDisclosing3: Glass In Foot Misdiagnosis

Practice a case with the AI patient 🤖

Summary:

This PLAB 2 scenario involves a telephone consultation with an angry parent whose child, George, continues to experience foot pain after a beach injury. A review of an X-ray revealed a missed glass fragment. The case tests the candidate’s ability to handle an angry patient, disclose a medical error, manage potential complications, and plan further care.

Key Points:

Angry Patient Management

• Identify if anger is present from the start or triggered after disclosure.

• Acknowledge the mistake openly and sincerely.

• Allow the patient or relative to express anger without interruption.

• Avoid defensive explanations or blaming colleagues.

• Maintain calm, empathetic demeanor throughout.

History Taking

• Confirm patient identity and relationship to child.

• Review timeline of events (injury, initial hospital visit, symptoms).

• Ask about current symptoms (pain, fever, discharge, redness).

• Enquire about immunization status, especially tetanus.

• Clarify if painkillers or other medications were prescribed.

• Check for any allergies.

Tetanus Immunization

• Understand childhood tetanus vaccination schedule.

• Protection lasts 10 years after the last dose (usually at 3 years, 4 months).

• If immunizations are up to date, additional tetanus shot is not needed.

• Confirm immunization status before finalizing decision.

Important Considerations:

• Always explicitly admit the medical error (“There was a mistake”).

• Avoid monologuing to prevent poor marks in interpersonal skills.

• Use neutral, non-defensive responses to patient concerns.

• Practice scenarios with aggressive tone to prepare emotionally.

Diagnostic Approach:

1. Gather full history and timeline of the injury.

2. Assess current symptoms to rule out infection or complications.

3. Confirm immunization status and previous treatments.

4. Interpret revised X-ray findings showing retained glass.

Management:

• Admit and explain the diagnostic oversight.

• Urgently advise return to hospital for assessment and removal of glass.

• Assess for complications (e.g., infection, fever).

• Pain management planning.

• Confirm no further tetanus shot is required if immunization up to date.

• Document the error and complete an incident report.

• Inform senior/consultant.

• Arrange follow-up post-removal.

• Safety netting: advise return if symptoms worsen (fever, spreading redness).

Communication Skills:

• Express empathy (“I can see that you’re upset…”).

• Validate concerns (“Anyone in your situation would feel the same…”).

• Avoid excuses or justifications.

• Ensure patient understands management plan.

• Use clear, jargon-free language.

• Signpost before disclosing new information.

Ethical Considerations:

• Transparency: Disclose errors honestly.

• Accountability: Take responsibility without shifting blame.

• Confidentiality: Maintain patient privacy despite discussing with guardian.

• Professionalism: Maintain calm and courteous demeanor even under pressure.

Additional Resources:

• GMC Good Medical Practice: Domains 2 & 4 (honesty, patient partnership).

• PLAB Examiner Tips: Importance of real interaction, avoiding rehearsed responses.

• Understanding Your Results: “Management” and “Rapport” are critical domains.