PUID: 62 || PLAB 2 Mock 7 :: Angry From Beginning4: IV Missed Allergy

examiner mla
5 days ago
3 min read

Summary

This PLAB 2 case tests the candidate’s ability to handle an angry relative following a near-miss medication error, where a child with a known penicillin allergy was almost administered penicillin. The consultation focuses on communication, professionalism, duty of candour, and patient safety.

Key Points

Main Focus: Communication and Professionalism

Patient (parent) is angry due to a near-miss error involving their child.
The doctor must demonstrate empathy, active listening, and non-confrontational communication.
The goal is to diffuse anger, gather facts, and outline steps for escalation and prevention.

Important Considerations

Always start with acknowledging the patient’s emotions:“I can see that you’re upset, and I’m very sorry for what you’ve experienced.”
Avoid defensive explanations or over-talking; allow the patient to vent.
Do not tell the patient to “calm down” — instead, validate feelings.
Maintain professional boundaries; avoid commenting on disciplinary outcomes.
Follow the GMC’s “Being open when things go wrong” and Duty of Candour principles.
Keep the focus on patient safety, incident reporting, and preventive strategies.

Diagnostic Approach

Since this is a communication-based station, the diagnostic aspect relates to fact-finding rather than clinical diagnosis.

Clarify the event:
- “Could you please tell me exactly what happened?”
- “When did this happen?”
Identify immediate harm:
- Check if the child received the medication or if harm occurred.
Confirm details of allergy documentation:
- Was it recorded in notes, on wristband, and on drug chart?
Determine contributing factors:
- Miscommunication, lack of documentation, or human error.

Management Plan

Immediate Actions

Apologize and express empathy without admitting legal liability.(“I’m sorry this has happened. I completely understand your concern.”)
Ensure child’s safety: confirm they did not receive penicillin and are stable.
Reassure that the situation will be escalated appropriately.

Escalation and Reporting

Document the event in the patient’s notes.
Complete an incident report for internal review and learning (per GMC guidance on “Responding to safety risks”).
Inform consultant/senior about the incident immediately.
Arrange an internal audit to review protocols and prevent recurrence.

Patient-Centred Measures

Discuss safety measures in place (e.g., allergy bracelets, highlighted chart entries).
Offer opportunity for follow-up discussion or complaint with the Patient Liaison or Complaints department.
Emphasize that system learning, not blame, is the goal.

Communication Skills

Active Listening: Allow the parent to speak fully before responding.
Empathic Phrasing:
- “I can see you’re angry, and you have every right to feel that way.”
- “I’d like to understand what happened so that I can help resolve this.”
Avoid over-explaining or being defensive.
Non-confrontational tone: Replace “Calm down” with validation statements.
Show understanding through body language—nods, pauses, attentive posture.
Reassure action, not blame: Focus on “next steps” and “safety improvement.”
Clarify your professional limits:
- “It’s not within my position to comment on disciplinary actions, but I will escalate this to the consultant.”

Ethical Considerations

Duty of Candour (GMC Domain 2) – Be open, honest, and apologetic when things go wrong.
Professional Boundaries – Do not criticise colleagues or promise disciplinary action.
Confidentiality – Discuss only relevant details pertaining to the child’s care.
Patient Safety First – Report incidents to prevent future harm.
Teamwork & Accountability – Collaborate with seniors and document all actions taken.

Additional Resources

GMC Good Medical Practice (2024):
- Being open if things go wrong (Domain 2, Paragraphs 45–47)
- Responding to safety risks (Domain 3, Paragraph 75)
NHS England – Duty of Candour Policy
GMC: Openness and Honesty when Things Go Wrong
PLAB 2 Examiner Guidance – Listening and Interaction
PLAB 2 Examiner Advice – Avoid rehearsed empathy and over-talking