PLAB 2 Communication Stations: Bad News, Angry Patient, Consent, Counselling Scripts

How PLAB 2 marks a communication station

Below are five complete PLAB 2 communication scripts, written by TalkDrill: breaking bad news, an angry patient, consent, counselling and a telephone station. Each is followed by examiner-style notes that tie what the doctor said to the three domains the GMC marks. Per the GMC PLAB 2 guide, PLAB 2 has 16 scenarios, each lasting eight minutes, and every scenario is marked on three domains: data gathering, technical and assessment skills; clinical management skills (formulating a diagnosis, explaining something to the patient, a management plan); and interpersonal skills (rapport, open and closed questioning, involving the patient, professionalism). The guide says interpersonal skills are tested by observing your interaction with another person, "usually a simulated patient or occasionally the examiner". So in a communication station you are being marked three ways at once. What you find out, what you explain and plan, and how you treat the person in front of you. The scripts show all three in eight minutes.

The shape of an 8-minute station, and SPIKES in plain English

Every script below follows the same spine: open, find out what they know and feel, explain in small pieces, plan, safety-net, close. For bad news, the spine has a well-known name. SPIKES is a widely taught six-step framework for breaking bad news. You never say its name in the station; it is a checklist in your head.

SPIKES step	What it means in plain English	A line you can say
Setting	Right person, right place, privacy, permission. Offer someone to be with them.	"Would you like anyone with you while we talk?"
Perception	Find out what they already know or suspect.	"What have you been told about why you had the test?"
Invitation	Ask how much they want to know, and how.	"Would you like the details, or the main points first?"
Knowledge	A warning shot, then the news in one plain sentence. No jargon.	"I'm afraid it's not what we hoped. The sample shows a cancer."
Emotions	Stop. Silence. Name the feeling. Wait.	"This is a lot to take in. Take your time."
Strategy and summary	The next step, who, when; a safety-net; a teach-back; a close.	"So the next step is a scan. What will you tell your family tonight?"

The clock is the other half. Our suggested split for practice, not a GMC rule: about 45 seconds to open, about two minutes to find out what they know and feel, three to four minutes to explain and answer their real question, and the last two minutes for the plan, the safety-net and the summary. In our judgement, the commonest failure is a candidate still asking questions at minute six. The practice bank has the same split as a table and 20 PLAB 2 scenarios to run it on.

Script 1: breaking bad news (a cancer result)

Doctor: Good morning. Mr Wilson? I'm Dr Ahmed, one of the doctors in the surgical team. Please, have a seat. Could I check your full name and date of birth?

Mr Wilson: (gives them)

Doctor: Thank you. Have you come on your own today? Would you like anyone with you while we talk?

Mr Wilson: No, my wife's not well. I look after her. It's just me.

Doctor: I'm sorry to hear she's unwell. I'd like to come back to that. Before I go through anything, could you tell me what you understand about why you had the camera test?

Mr Wilson: My bowels changed. Looser, for a couple of months. They took some samples. My dad had bowel cancer, so I've been thinking about it.

Doctor: Thank you, that's very clear. So you've been worried it might be something serious, because of your dad.

Mr Wilson: I have.

Doctor: The results of the samples are back. Would you like me to go through them in detail, or would you prefer the main points first?

Mr Wilson: Just tell me straight. I don't like beating about the bush.

Doctor: I will. I'm afraid the results are not what we'd hoped for. (pause) The samples show that there is a cancer in the bowel.

(Mr Wilson is silent, looking at the floor. The doctor waits.)

Doctor: I'm so sorry. This is a lot to take in. Take your time.

Mr Wilson: (after a long pause) Has it spread?

Doctor: That's the most important question, and I don't know the answer yet. We've booked a CT scan, which looks at your tummy and chest. It shows whether the cancer is only in the bowel or has spread anywhere else, and that's what decides the best treatment. Is it all right if I explain what happens next?

Mr Wilson: Go on.

Doctor: After the scan, a team of specialists, surgeons, cancer doctors, X-ray doctors and nurses, look at all your results together and recommend a plan for you. For many people with bowel cancer, the main treatment is an operation to remove the part of the bowel with the cancer, and sometimes other treatments are added. I don't want to say which until we have the scan. Does that make sense so far?

Mr Wilson: Yes. (pause) How long have I got?

Doctor: I can understand you wanting to know that. Honestly, I can't give you a timescale today, and it wouldn't be fair to guess. The scan will tell us a great deal more, and when we have it we'll talk about it openly.

Mr Wilson: My dad died of it.

Doctor: That must make this feel very frightening. Treatment has changed a lot, and every person's cancer is different. We'll find out exactly what yours is.

Mr Wilson: Who's going to look after my wife if I'm in hospital?

Doctor: That's a really important worry, and I'm glad you said it. Your specialist nurse, who'll be your main contact, can help arrange support at home, and we can involve your GP and social services. Is there family or a friend who could help?

Mr Wilson: My daughter lives an hour away.

Doctor: Would it help if she came with you when we have the scan results?

Mr Wilson: Yes. I think so.

Doctor: Before you go: if you notice heavy bleeding from the back passage, severe tummy pain, or you start vomiting, please come straight to A&E. Don't wait for the appointment. And so I know I've explained it clearly, what will you tell your daughter tonight?

Mr Wilson: That they found cancer in my bowel, I'm having a scan to see if it's spread, and then a team decides the treatment.

Doctor: That's exactly right. The specialist nurse will phone you this week; her number is on this card. Is there anything else you'd like to ask today?

Mr Wilson: No. Thank you for being straight with me.

Script 2: an angry patient (a missed fracture)

Doctor: Hello, Ms Jenkins? I'm Dr Hassan, one of the doctors in the emergency department. Thank you for coming back in. How is the wrist?

Ms Jenkins: How do you think it is? It's killing me. Someone rang and said there's a problem with my X-ray. So what is it?

Doctor: I'm sorry it's so painful. I'll explain exactly what happened. Can I first ask what you were told when you came in?

Ms Jenkins: That it was a sprain. Rest it, take painkillers, it'll be fine in a week or two. So I went back to work.

Doctor: Thank you. I need to be open with you. After you left, your X-ray was looked at again by a specialist in reading X-rays. They found a small break in one of the bones in your wrist, called the scaphoid. It was missed on the day you came in. I'm very sorry.

Ms Jenkins: So I've been working on a broken wrist for ten days? I'm a hairdresser. I've been holding scissors all day with a broken wrist!

Doctor: (pause) You're right to be angry. You were told it was a sprain, you went back to work in pain, and that should not have happened. I'm sorry.

Ms Jenkins: Sorry doesn't really help, does it? Who looked at it? Was it a student?

Doctor: I understand why you want to know. I'm not going to blame an individual, because what matters most is finding out how it happened so it doesn't happen again. We've reported it as an incident, which means it will be looked into properly, and you can ask to see what we find.

Ms Jenkins: Will it heal?

Doctor: That's the most important thing, so let me explain. This bone can be slow to heal, because of the way its blood supply works. The best thing now is to protect it. We'll put your wrist in a cast today, and the fracture clinic, the bone specialists, will see you to check it's healing. Does that make sense so far?

Ms Jenkins: I suppose. How long will I be in the cast? I can't cut hair in a cast.

Doctor: The fracture clinic will decide, based on how it heals, so I can't promise a date today. I know that affects your work and your income. I can give you a fit note. Are you employed or self-employed?

Ms Jenkins: I rent a chair in a salon. If I don't work, I don't get paid.

Doctor: That's really hard, and I'm sorry this has added to it. If you'd like to make a formal complaint, the Patient Advice and Liaison Service, PALS, can explain how.

Ms Jenkins: I will be complaining.

Doctor: That's absolutely your right, and I'll give you their details before you leave. While you're in the cast, if your fingers go numb, pale or blue, or very swollen, or the pain gets much worse, come back straight away. Don't wait for the clinic. Can I check I've been clear? What happens next?

Ms Jenkins: Cast today, the bone clinic checks it, come back if my fingers go numb or swollen, and PALS if I want to complain.

Doctor: Exactly. Once again, I'm sorry this happened. Is there anything else I can do for you today?

Script 3: consent (an endoscopy)

Doctor: Hello, Mrs Ahmed? I'm Dr Wright, one of the doctors in the stomach and bowel team. You've been booked for a camera test of your stomach, and I'd like to explain it so you can decide whether to go ahead. Is that all right?

Mrs Ahmed: Yes. I'm a bit nervous about it, to be honest.

Doctor: That's very common. What do you know about the test so far?

Mrs Ahmed: Only that it's a camera. My friend had one. She said she felt like she was choking.

Doctor: That sounds frightening to hear. Is choking your main worry?

Mrs Ahmed: Yes. And I don't understand why I need it. My GP said my iron is low. I thought I just needed iron tablets.

Doctor: Those are both important, so let me take them one at a time. First, why we're recommending it. Your iron is low and you've had indigestion. Iron can be lost slowly through the stomach or gut without you noticing, for example from an ulcer or inflammation. Iron tablets would top it up, but they wouldn't tell us why it's low. The camera test can find the cause. Does that make sense?

Mrs Ahmed: I think so. Are you looking for cancer?

Doctor: That's a fair question, and I'll be honest with you. Yes, we do check for cancer, because that's the sensible thing to do when iron is low. But many people's results show something less serious, like an ulcer or inflammation, which can be treated. Whatever we find, we'll explain it to you.

Doctor: Now, what actually happens. You lie on your side. A thin, bendy tube with a small camera on the end goes in through your mouth, down the food pipe and into your stomach. You can breathe normally the whole time, because the tube goes down the food pipe, not the windpipe.

Mrs Ahmed: So I won't choke?

Doctor: You may want to gag as it goes in, which is normal and passes. But your breathing isn't blocked. To make it easier, there are two choices. A throat spray numbs the back of your throat, and you're fully awake. Or sedation, an injection that makes you relaxed and drowsy. With sedation you'll need someone to take you home and stay with you, and you mustn't drive afterwards; the unit will tell you for how long.

Mrs Ahmed: Sedation, I think. My son can bring me.

Doctor: That's fine. Now the risks. It's a safe, common test. Your throat may be sore for a day or so afterwards. There are rare risks: bleeding, a small tear in the gut, or a reaction to the sedation. If they happen, they're treated. Is there anything about those you'd like me to explain more?

Mrs Ahmed: No, that's clear.

Doctor: And you do have a choice. You could decide not to have the test. We'd keep treating the low iron, but we might miss the cause. It's your decision, and you don't have to make it today.

Mrs Ahmed: No, I'll have it.

Doctor: Thank you. So I know I've explained it well, could you tell me in your own words what the test involves?

Mrs Ahmed: A thin tube with a camera through my mouth into my stomach, to find out why my iron is low. Sedation, so my son takes me home. A small chance of bleeding or a tear.

Doctor: That's exactly right. The unit will tell you when to stop eating and drinking beforehand. After the test, if you get chest pain, tummy pain that's getting worse, or you vomit blood or pass black poo, come straight to A&E. Here's a leaflet with all of this. Any questions?

Script 4: counselling (stopping smoking)

Doctor: Hello, Mr Hughes? I'm Dr Patel. Come in, have a seat. You came in last week with a cough and had a chest X-ray. The result was normal, which is good news.

Mr Hughes: Right. So what's the cough, then?

Doctor: What do you think it might be?

Mr Hughes: Smoker's cough. I've had it for years, it's just worse this winter. I was hoping for some cough medicine.

Doctor: Thank you. You're right that smoking is the most likely cause. Would it be all right if we spent a few minutes talking about the smoking today?

Mr Hughes: (folds his arms) Everyone tells me to stop.

Doctor: I'm not going to lecture you. I'd like to understand how you see it. How do you feel about your smoking at the moment?

Mr Hughes: I know it's bad. I've tried. Twice. Lasted a week each time.

Doctor: Two attempts tells me you really do want to stop. What got in the way?

Mr Hughes: I was like a bear with a sore head. I put on weight. Then I'd have a stressful day and that was it.

Doctor: So the cravings, the irritability and the weight. How did you try to stop?

Mr Hughes: Just willpower.

Doctor: That's really useful to know. Using support makes stopping more likely than willpower alone. Can I explain the two parts of that support?

Mr Hughes: Go on.

Doctor: The first part is medicine for the cravings. The most common is nicotine replacement, like patches or gum. A patch gives your body a steady, small amount of nicotine, without the smoke, the tar and the carbon monoxide, which are what damage your lungs. So the cravings and the irritability are much smaller. There are also tablets that reduce cravings, which we can talk about. Does that make sense so far?

Mr Hughes: Do those patches actually work, or is it all willpower?

Doctor: Good question. They work, and they work best with the second part, which is a stop-smoking adviser. The adviser helps with the habit: the stressful day, the cigarette with your tea. Some people use gum for sudden cravings on top of a patch.

Mr Hughes: And the weight?

Doctor: Some people put on a little. The adviser can help with that, and the health gain from stopping is far bigger. Can I ask, is there anything that would make stopping worth it to you?

Mr Hughes: My daughter's getting married next summer. I'd like to walk her down the aisle without coughing. (pause) And my dad had a heart attack at sixty. I think about that.

Doctor: Thank you for telling me that. It sounds like it really matters to you. Stopping smoking is one of the best things you can do for your heart.

Mr Hughes: OK. What do I do?

Doctor: Here's what I'd suggest, but it's your choice. You pick a quit date in the next couple of weeks. I'll refer you to the local stop-smoking service; they'll see you before that date and start the patches. How does that sound?

Mr Hughes: I can do that.

Doctor: Great. One more thing about the cough. If it's still there in a few weeks, or you cough up blood, lose weight without trying, or get more breathless, come back sooner. Can you tell me the plan, so I know I've explained it well?

Mr Hughes: Pick a date, the stop-smoking people see me, patches, and come back if the cough doesn't settle or I cough up blood.

Doctor: Perfect. I hope you'll be breathing easily at that wedding. Any questions?

Script 5: a telephone station (a death)

If a scenario puts you on the phone, the rules change. There is no face, no hand on the arm, no tissues. Everything the patient or relative learns about your kindness comes through your voice: pace, pauses and words. Telephone conversations, with a relative, a patient or a colleague, are a familiar shape in PLAB 2 preparation. Ours is a relative and a death.

Mrs Clarke: Hello?

Doctor: Hello, could I speak to Mrs Susan Clarke, please?

Mrs Clarke: Speaking.

Doctor: Mrs Clarke, my name is Dr Mensah. I'm one of the doctors on Ward 7 at the hospital, where your father, Mr Thomas Brown, is a patient. Are you somewhere you can talk for a few minutes? You're not driving?

Mrs Clarke: No, I'm at home, getting ready for work. Is everything all right?

Doctor: What were you told about your father yesterday?

Mrs Clarke: The nurse said he was comfortable. Very poorly with the pneumonia, but comfortable.

Doctor: Thank you. I'm afraid I'm calling with very sad news. Is anyone with you at the moment?

Mrs Clarke: My husband's here. What's happened?

Doctor: Your father's breathing changed early this morning, and I'm very sorry to tell you that he died, at about half past four.

(Silence. Mrs Clarke is crying.)

Doctor: I'm so sorry. (pause) Take your time. I'm still here.

Mrs Clarke: Was he on his own? Was he in pain?

Doctor: A nurse was with him. He was settled, and he didn't appear to be in pain. When his breathing changed, it happened very quickly, within a few minutes.

Mrs Clarke: Why didn't anyone call me in the night? I would have come. I went home last night. I shouldn't have gone home.

Doctor: I'm so sorry you didn't get that call. It happened so quickly that there wasn't time for anyone to call you and for you to get here. Going home last night was a completely reasonable thing to do. You couldn't have known.

Mrs Clarke: (crying) I just wish I'd been there.

Doctor: That's completely understandable. (pause) Would it help if I explained what happens next, or would you rather I called back a little later?

Mrs Clarke: No, tell me now.

Doctor: You and your family are welcome to come and see him on the ward this morning. When you arrive, ask for the nurse in charge, who'll take you to him. After that, the hospital's bereavement office will explain the next steps, including the death certificate. They'll call you, or you can call them.

Mrs Clarke: Do I need to bring anything?

Doctor: Nothing today. Just come when you're ready. Can I ask you not to drive while you're this upset? Could your husband drive you?

Mrs Clarke: Yes, he'll drive.

Doctor: Good. Just so I know I've been clear, what will you do now?

Mrs Clarke: Come to Ward 7 with my husband, ask for the nurse in charge, and the bereavement office will ring about the certificate.

Doctor: That's right. Let me give you the ward's direct number. Have you got a pen? (gives it) Again, I'm so sorry for your loss. We'll see you when you arrive.

What loses marks: twelve habits and their fixes

These are twelve habits that, in our judgement, most often cost marks in communication stations. The domain column is our reading of where each habit costs marks; for PACES candidates, the marksheet wording is quoted from the Federation's Station 1 Communication marksheet.

Habit	What the examiner sees	Domain it costs	The fix
Jargon left unexplained ("biopsy", "malignancy", "anticoagulant")	A patient who nods and understands nothing	Clinical management (explaining); PACES C lists "uses jargon"	One plain sentence per term. See the 120 plain-English swaps.
No ideas, concerns or expectations	Answers to questions the patient never asked; the hidden worry never found	Interpersonal; data gathering	Three questions in the first two minutes: what do you think, what worries you, what were you hoping for.
No summary or teach-back	No evidence the patient understood	Clinical management; the PACES marksheet describes a satisfactory skill F candidate as one who "confirms patient's or relative's understanding"	"So I know I've explained it well, what will you tell your family?"
No safety-net, or a vague one	A patient who leaves without knowing when to come back	Clinical management	Name two or three specific signs and say where to go.
A two-minute monologue	Information dumped, not shared	Interpersonal; clinical management	Chunk and check: one or two sentences, then "Does that make sense?"
Filling the silence after bad news	The patient stops listening	Interpersonal	Say the news, then count to five in your head before speaking.
False reassurance ("Don't worry, it's probably nothing")	A promise the doctor cannot keep	Clinical management; professionalism	Honest uncertainty plus a next step: "I don't know yet. The scan will tell us."
Defending the hospital or blaming a colleague	An angry patient who gets angrier	Interpersonal; professionalism	Apologise for their experience; report the incident; offer the complaints route.
Interrupting an angry patient	A patient who was not heard	Interpersonal	Let them finish. Then name the feeling.
Euphemisms for death ("passed", "we lost him")	A relative left unsure what happened	Interpersonal	Use "died". It is the kind word.
Working through the card in order, like a checklist	A station that sounds like a form	Interpersonal	Follow the patient's agenda, then cover what is left.
Still asking questions at minute six	No time for the plan	Clinical management	Practise with the clock and the split in the practice bank.

Two of these deserve a word for doctors whose first language is not English. A direct instruction ("You have to stop smoking") that sounds ordinary in many clinics where Hindi, Urdu, Malayalam or Arabic is spoken can sound like an order in a British consultation, and it can come across as not involving the patient. And a flat intonation on questions can make "Does that make sense?" sound like a statement, so the patient does not answer. Both can be fixed with regular recorded practice; the first-language mistakes page has the drills.

How to practise these scripts

1. Read one script aloud, both parts, against the clock. You will find it runs close to eight minutes at a calm pace. If you finish in five, you are rushing the pauses.
2. Close the page and run the same scenario with a partner. The bank versions (P06, P12, P16, P01 and P08 on the practice bank page) have the patient brief your partner needs. Say it your way, not ours.
3. Record and mark yourself on the three-domain sheet in the bank. Pick one habit from the table above to fix next time.
4. No partner? Rehearse the spoken part with the TalkDrill AI role-play, which plays the other person so you can practise the lines aloud under time.
5. Polish the sound. If the recording shows stress on the wrong syllable of medical words, use the word stress drill. For general patient-facing English, our guide to English for doctors and patient communication covers the everyday phrases.

For the format, booking rules and results timing, see the PLAB 2 format and fees page, and for the official wording read the GMC pages directly: what is the PLAB 2 exam and how will you be tested (read in a browser on 21 October 2026; we could not re-check them this week). If you are sitting PACES rather than PLAB 2, the same moves apply, but the clock is 10 minutes and the marks are skills C, E, F and G; the PACES encounters page explains the difference. Everything else is on the PLAB 2 and PACES communication hub.