PUID: 63 || PLAB 2 Mock 8 :: UnethicalRequests3: Sick Note Malingering Drunk Driver

Practice a case with the AI patient 🤖

Summary:

This station focuses on managing a patient requesting a false sick note after a road traffic accident. The key challenge is balancing empathy with professional integrity while maintaining clear boundaries.

Key Points:

1. Communication & Consultation Structure

• Warm greeting, introduce yourself, confirm patient identity

• Use open-ended questions to explore concerns

• Allow patient to explain situation fully

• Maintain structured and logical flow in consultation

• Summarise findings to build rapport and confirm understanding

2. History Taking (Focused & Relevant)

• Explore:

  • Details of accident (how, when, speed, seatbelt use)

  • Alcohol intake (amount, timing before driving)

  • Post-accident symptoms:

    • Neck pain, stiffness

    • Headache

    • Confusion (important for head injury)

    • Neurological symptoms (tingling, numbness)

• Clarify whiplash mechanism and severity

3. Psychosocial & Occupational Aspects

• Explore:

  • Reason for requesting sick note

  • Employment concerns (e.g., job loss risk)

  • Whether patient has spoken to employer

• Offer alternatives:

  • Discuss modified duties

  • Suggest employer communication

  • Signpost to support services (e.g., Citizens Advice Bureau)

4. Clinical Knowledge – Whiplash

• Involves:

  • Sternocleidomastoid and trapezius muscles

• Possible complications:

  • Muscle spasm or ligament injury

  • Nerve root compression (commonly C7)

• Red flag symptoms:

  • Tingling/numbness (especially fingers)

  • Weakness in arm movement

5. Professional Boundaries & Ethics

• Clearly refuse to provide a false sick note

• Explain:

  • Legal and professional implications

  • Duty of honesty and integrity

• Maintain calm, non-judgmental tone

• Reinforce boundaries confidently

6. Management & Support

• Offer:

  • Documentation of actual findings

  • Referral to occupational health

  • Psychological support if distressed

• Address:

  • Stress and emotional impact

  • Mood assessment

7. Safety Netting

• Essential in every station:

  • Advise patient to return if:

    • Worsening neck pain

    • Numbness/tingling

    • Weakness in arms

• Provide clear follow-up instructions

Important Considerations:

• You do NOT fail if the patient remains unhappy

• Setting boundaries = mark scoring behavior

• Avoid overpromising or unnecessary referrals

• Stay focused on the task requirement

• Maintain professionalism even under pressure

Diagnostic Approach:

1. Take focused history of accident

2. Assess symptoms (pain, neurological, cognitive)

3. Identify red flags (confusion, neurological deficits)

4. Evaluate psychosocial impact

5. Rule out serious injury

Management:

• Immediate:

  • Reassure and explain findings

  • Provide analgesia advice if appropriate

• Refusal of request:

  • Politely decline false documentation

• Support:

  • Occupational advice

  • Psychological support if needed

• Documentation:

  • Record patient request and your response clearly

• Follow-up:

  • Safety net and review if symptoms worsen

Communication Skills:

• Use active listening and validation

• Avoid:

  • Stock phrases or rehearsed empathy

• Be:

  • Clear, concise, and confident

• Use signposting:

  • “I’d like to ask about your accident…”

• Maintain:

  • Eye contact

  • Open body language

Ethical Considerations:

• Honesty and integrity are mandatory

• Do not falsify documents

• Balance:

  • Patient autonomy vs professional duty

• Maintain professional boundaries

• Protect public safety (driving under influence)

Additional Resources:

• GMC Good Medical Practice guidelines

• PLAB 2 Examiner Top Tips

• Common PLAB 2 Mistakes Guide

• PLAB 2 Marking Domains & Feedback