PUID: 63 || PLAB 2 Mock 4 :: LGBTQ2: LGBTQ PAP Smear

examiner mla
Apr 12
2 min read

Summary:

This station involves counselling a patient (lesbian) who is reluctant to attend cervical screening due to misconceptions and discomfort. The focus is on addressing concerns sensitively, correcting misunderstandings, and maintaining patient-centred communication.

Key Points:

1. Communication & Patient-Centred Approach

Avoid jumping into sensitive topics (e.g., sexual history) without context
Always signpost before asking personal questions:
- Explain why the question is relevant
Recognise and respond to emotions (e.g., discomfort, defensiveness)
Use ICE:
- Ideas: What does the patient think about the test?
- Concerns: Why are they reluctant?
- Expectations: What do they want from the consultation?
Avoid assumptions based on sexual orientation or appearance

2. Addressing Misconceptions

Common misconceptions:
- Cervical screening is only for heterosexual women
- Procedure is painful or unnecessary
Explore understanding:
- “What do you understand about cervical screening?”
Correct gently using tailored explanations

3. LGBTQ-Sensitive Consultation

Do not immediately focus on sexual orientation or transition history
Treat presenting concern first (e.g., screening query)
Only explore LGBTQ-specific aspects if clinically relevant
Avoid making patient feel “different” or repeatedly questioned about identity
Respect dignity and avoid discrimination

4. Telephone Consultation Etiquette

Confirm:
- Name
- Age
- First line of address
Ensure communication clarity:
- “Can you hear me clearly?”
Safety net:
- Confirm callback number if disconnected
Maintain structured flow

5. Consultation Structure

Start with concern → explore understanding → identify misconceptions → provide explanation → shared decision
Avoid disorganised questioning (a common exam pitfall)

Important Considerations:

Do not ask sensitive questions abruptly without justification
Avoid appearing rehearsed or robotic
Do not rely on stereotypes or appearance cues
Manage difficult or rude patients calmly
Always maintain professionalism and empathy

Diagnostic Approach:

(For this station – conceptual rather than clinical diagnosis)

Identify reason for consultation (screening invitation concern)
Explore:
- Understanding of cervical smear
- Beliefs about HPV risk
Identify misconceptions:
- Sexual orientation-related misunderstanding
Assess risk factors (only if relevant and sensitively approached)
Rule out red flags (e.g., symptoms like bleeding, pain if mentioned)

Management:

1. Education & Counselling

Explain:
- Cervical screening detects early changes → prevents cancer
- HPV transmission is not limited to heterosexual intercourse
Clarify:
- Procedure is quick and usually not very painful

2. Address Concerns

Validate feelings:
- “I understand this can feel uncomfortable”
Provide reassurance with facts

3. Shared Decision Making

Respect autonomy if patient declines
Offer time to reconsider

4. Safety Netting

Advise:
- Seek help if symptoms develop (bleeding, discharge, pain)
Offer follow-up or further discussion

Communication Skills:

Use signposting effectively
Avoid phrases like:
- “Can I ask personal questions?” (sounds awkward)
Instead:
- “To understand your concern better, I’d like to ask a few questions…”
Handle resistance:
- Acknowledge + reframe question
Stay calm with challenging behaviour
Adapt questioning style if patient becomes uncomfortable

Ethical Considerations:

Respect patient autonomy and choices
Avoid discrimination based on sexual orientation
Maintain confidentiality
Ensure informed decision-making
Provide equitable care

Additional Resources:

GMC Good Medical Practice – communication, respect, non-discrimination
PLAB 2 Examiner Top Tips – avoid assumptions, structured consultation
GMC PLAB Feedback Framework – importance of rapport, listening, and structure