PUID: 51 || PLAB 2 Mock 8 :: AngryFromBeginning4: IV Missed Allergy

Practice a case with the AI patient 🤖

Summary:

This case involves a distressed mother whose child, known to be allergic to Augmentin, was almost administered the medication due to a hospital error. The candidate must handle an emotionally charged interaction with empathy, gather information, acknowledge the mistake, and propose steps for resolution and prevention.

Key Points:

Emotional Recognition and De-escalation

• Immediately acknowledge strong emotions: “I can see that you’re upset/angry.”

• Use open-ended questions: “Could you tell me more about what happened?”

• Validating emotions helps de-escalate the situation and builds rapport.

History/Data Gathering

• Clarify the sequence of events leading to the error:

  • Why the child was brought in (e.g., symptoms like runny nose, cough)

  • How the allergy was communicated

  • Who prescribed and attempted to administer the medication

  • Whether the medication was actually administered

Clinical Concerns

• Confirm child’s current condition.

• Ensure child is now on appropriate treatment.

• Confirm no allergic reaction occurred.

Important Considerations:

• Own the mistake: Acknowledge the error clearly and apologize.

• Avoid minimizing the incident (e.g., never say it happens “often”).

• Emphasize hospital protocols and your commitment to preventing recurrence.

• Do not suggest PALS unless the parent brings up complaints or the situation warrants feedback.

Diagnostic Approach:

1. Presenting Complaint: Ask about original symptoms.

2. Incident Timeline: Confirm when and how the medication error happened.

3. Communication Chain: Who was informed about the allergy, and how it was missed?

4. Allergy Documentation: Check and document allergy thoroughly.

5. Clinical Status: Assess the child’s current health.

Management:

• Immediate Actions:

  • Confirm the child did not receive the medication.

  • Ensure the correct antibiotics are now in use.

• Communication with Team:

  • Speak to involved staff (nurses, doctors).

  • Escalate to senior staff or consultant.

• Documentation:

  • Ensure allergy is clearly recorded in all notes and on wristbands.

• Safety Netting:

  • Discuss warning signs and when to seek help.

• Follow-up:

  • Arrange review with GP and provide leaflets.

Communication Skills:

• Use empathetic language throughout.

• Validate patient’s concerns and emotions sincerely.

• Avoid defensive or rehearsed language.

• Signpost transitions clearly (e.g., “I’d like to understand what happened...”).

• Avoid phrases like “Is that okay?” or “May I ask…” which can appear artificial.

Ethical Considerations:

• Duty of Candour: Be open and honest when things go wrong.

• Professionalism: Avoid blaming others; speak objectively about the incident.

• Consent and Autonomy: Involve the parent in decisions regarding next steps and feedback pathways.

Additional Resources:

• GMC’s Good Medical Practice – sections on openness, patient communication, and professionalism.

• PLAB 2 Examiner Tips – avoid stock phrases, perform relevant history and logical consultation structure.

• Understanding Your Results Document – feedback on disorganized consultation and missing key issues often apply in such stations.