Colleague Consultation · Intermediate · Communication

Addressing Potential Doctor-Patient Boundary Violations

Practise this PLAB 2 colleague consultation station on Doctor-Patient Boundary Violation. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are a senior registrar on a busy ward. A senior nurse approaches you privately to express concern about your colleague Dr Hassan Khan's behaviour toward a female patient. The nurse has observed what appears to be inappropriate familiarity, excessive time spent with this particular patient, and comments that suggest personal rather than professional interest. You need to address this sensitively but firmly.

Background notes: PMH: Nil significant

What this station tests

  • Doctor-patient boundary violation as a safeguarding matter: power imbalance makes any relationship inappropriate
  • Escalation to clinical director or medical director: not for you to investigate
  • GMC guidance: romantic or sexual relationships with current patients are never acceptable
  • Protecting the patient: different doctor assigned while investigation proceeds
  • Supporting the reporter: 'you did the right thing' without promising outcomes

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself and your role. State the purpose of the consultation clearly.
  • 1-3 min — Present Case: Use SBAR structure. Situation, Background, Assessment, Recommendation. Be concise and relevant.
  • 3-5 min — Discussion: Discuss differential diagnosis and management. Listen to colleague's perspective. Share concerns professionally.
  • 5-7 min — Agree Plan: Agree on management plan. Clarify roles and responsibilities. Discuss escalation criteria.
  • 7-8 min — Closing: Summarise agreed actions. Confirm documentation. Arrange follow-up communication.

Consultation approach

The opening

A nurse reporting concern about a doctor's boundary violation with a patient is a serious safeguarding matter. Nurse Christine Okafor (54, experienced) has observed inappropriate behaviour. Open with: 'Christine, thank you for coming to me with this. I take this very seriously. Tell me exactly what you have seen.'

Core approach

Listen to the specific concern. What behaviour has she observed? (Extended time in patient's room with door closed, personal phone number exchanged, overly familiar language, gifts.) Is the patient vulnerable? (Physical or mental health condition, power imbalance.) Has anyone else witnessed it?

This is a safeguarding issue, not a personality issue. A doctor-patient relationship involves a power imbalance. Romantic or sexual relationships with current patients are always inappropriate per GMC guidance. Even after the clinical relationship ends, there is a cooling-off period.

You cannot investigate this yourself. It must be escalated to the clinical director, hospital safeguarding lead, or medical director. The patient may need to be protected (different doctor assigned). The doctor under concern must be informed and may be restricted while the investigation proceeds.

Closing and safety netting

Actions: escalate to clinical director or medical director today. Document Christine's report (with her consent). The patient must be safeguarded. The doctor will be informed as part of the investigation process. Support Christine: 'You did the right thing raising this. I will make sure it is handled properly.' Do not investigate yourself: this is for governance to manage. Follow-up: confirm to Christine that the concern has been escalated.

How examiners mark this station

Examiners will assess both Domain 1 (Data Gathering) and Domain 2 (Clinical Management) as primary: clarity and structure of your case presentation, appropriateness of your clinical reasoning, and whether you agree a clear plan. Domain 3 (Interpersonal Skills) assesses professional communication and collaborative approach.

Domain 1 (Primary focus)

Scores well: Specific behaviours documented. Patient vulnerability assessed. Witnesses identified. Power imbalance recognised.

Costs marks: Not documenting specifics. Not assessing vulnerability.

Domain 2 (Primary focus)

Scores well: Escalated to clinical director. Patient safeguarded. Reporter supported. Documentation. Not self-investigating.

Costs marks: Self-investigating. Not escalating. Not protecting patient.

Domain 3 (Primary focus)

Scores well: Taking the report seriously. Supporting Christine. Professional handling. Not gossiping.

Costs marks: Dismissing. Gossiping. Not supporting reporter.

Common examiner feedback (and how to fix it)

Did not communicate clinical information effectively

Fix: Use SBAR (Situation, Background, Assessment, Recommendation) every time. State clearly what you need from the colleague at the outset.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Before ending, confirm: What is the plan? Who is doing what? When will you communicate next? Document the agreed plan.

Common mistakes in this station

  1. Investigating yourself: boundary violations require formal governance investigation
  2. Dismissing the concern: a senior nurse reporting this has seen something concerning
  3. Not protecting the patient: they may be vulnerable and need a different doctor assigned

Resitting PLAB 2?

If colleague consultation stations have been challenging, practise the SBAR format until it is automatic. The most common issue is failing to clearly state why you are consulting the colleague and what you need from them. Be direct about your clinical question.

Example opening

Hello, this is Dr [Name], I'm the FY2 on [ward]. Thank you for taking my call. I'd like to discuss a patient I'm looking after and get your advice on management.

Frequently asked questions

How should I approach this doctor-Patient boundary violation colleague consultation?

A nurse reporting concern about a doctor's boundary violation with a patient is a serious safeguarding matter. Nurse Christine Okafor (54, experienced) has observed inappropriate behaviour. Open with: 'Christine, thank you for coming to me with this.

What are examiners marking in this doctor-Patient boundary violation station?

Marks are won for: Specific behaviours documented. Patient vulnerability assessed. Witnesses identified. Power imbalance recognised. Marks are lost for: Not documenting specifics. Not assessing vulnerability.

What is the most common mistake candidates make in this doctor-Patient boundary violation station?

Investigating yourself: boundary violations require formal governance investigation. Another frequent error: Dismissing the concern: a senior nurse reporting this has seen something concerning.

How do I prepare for this station if I have not managed doctor-Patient boundary violation in clinical practice?

This station rewards process over personal experience. The skill being assessed: Escalation to clinical director or medical director: not for you to investigate. The written guidance on this page covers the full approach, and practising the consultation aloud builds the fluency the examiner is listening for.

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