Angry Patient · Intermediate · Communication

Angry Son Speaking on Behalf of His Mother

Practise this PLAB 2 angry patient station on Hip Fracture (Post-Fall). 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in the acute medical unit. Mr Alan Fisher, aged 51, is very angry about the care his mother Mrs Elizabeth Fisher (aged 79) has received during her admission. She had a fall at home, was admitted with fractures, and Alan feels she has been neglected and her needs not met. Please listen empathetically, understand his concerns, address them professionally, and work together to improve his mother's care.

Background notes: PMH: Nil significant

What this station tests

  • De-escalation through listening: let him speak fully before responding
  • Acknowledging each concern specifically: not a generic 'I am sorry you feel that way'
  • Providing a factual clinical update: this often de-escalates by showing action
  • Committing to improvement: regular updates, named nurse, ward contact number
  • Recognising fear beneath the anger: he is frightened for his mother

How to use your 8 minutes

  • 0-1 min — De-escalation: Stay calm. Introduce yourself. Acknowledge their frustration. 'I can see you're upset, and I want to help.'
  • 1-3 min — Active Listening: Let the patient express their concerns fully. Do not interrupt. Use reflective statements. Show empathy.
  • 3-5 min — Acknowledge and Explain: Validate their feelings. Explain what happened (if appropriate). Take responsibility where due. Avoid being defensive.
  • 5-7 min — Resolution: Discuss what can be done. Offer concrete actions. Involve senior/PALS if needed. Set realistic expectations.
  • 7-8 min — Closing: Summarise agreed actions. Confirm follow-up plan. Offer formal complaints process if requested.

Consultation approach

The opening

An angry relative requires the same de-escalation approach as an angry patient: listen, acknowledge, then act. Mr Fisher (51) is furious about his 79-year-old mother's care after a fall. She fractured her hip and he feels the team has been negligent. Open with: 'Mr Fisher, I can see how worried and frustrated you are about your mother. Please tell me everything that concerns you.'

Core approach

Let him speak fully. He is angry about: delayed ambulance response, waiting time in A&E, his mother being in pain, lack of communication (nobody told him what was happening for hours), and feeling excluded from care decisions. Some concerns may be justified, others may reflect the normal emergency pathway.

Acknowledge each concern specifically, not generically. 'I understand the wait in A&E was very stressful for you and your mother. I agree that you should have been kept informed.' Do not dismiss any concern, even if you think the care was appropriate.

Provide an update on his mother. She has had her X-ray, the fracture is confirmed, she is on analgesia, and she is scheduled for surgery. This factual update often de-escalates because it shows the team is acting. Explain what happens next.

Closing and safety netting

Commit to improvement for the remainder of her stay. 'I will make sure you are updated regularly from now on. Here is the ward number and the name of her named nurse.' If he wants to complain formally: PALS. If he raises patient safety concerns: these must be escalated through the appropriate channel.

Address his underlying emotion: he is not just angry, he is frightened for his mother. 'I can see how much you love your mum. She is in good hands and we are going to look after her.' Follow-up: regular updates as promised.

How examiners mark this station

Examiners will focus primarily on Domain 3 (Interpersonal Skills): your ability to remain calm, de-escalate, actively listen, and maintain professional boundaries. Domain 2 (Clinical Management) assesses whether you offered concrete resolution and knew the complaints process. Domain 1 (Data Gathering) assesses whether you fully understood the source of the patient's anger.

Domain 1 (Supporting)

Scores well: Mother's current status conveyed. Treatment plan explained. Communication gap identified.

Costs marks: Not providing clinical update.

Domain 2 (Primary focus)

Scores well: Communication plan for rest of stay. Named nurse. PALS offered. Complaints escalated if safety concern.

Costs marks: No communication plan. Dismissing complaint.

Domain 3 (Primary focus)

Scores well: Listening fully. Acknowledging specifically. Recognising fear beneath anger. Providing reassurance through action. Not being defensive.

Costs marks: Defensive. Dismissive. Generic apology. Not recognising his fear.

Common examiner feedback (and how to fix it)

Did not demonstrate adequate interpersonal skills in managing the consultation

Fix: Practise staying calm under pressure. Acknowledge the anger explicitly ('I can see you are very frustrated'). Let the patient speak fully before responding. Never become defensive.

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

Fix: After de-escalation and active listening, offer concrete next steps. Explain the complaints process (PALS). Involve senior staff if needed. Document the interaction.

Common mistakes in this station

  1. Being defensive about the team's care: even if care was appropriate, his experience of it was poor
  2. Dismissing his concerns as unreasonable: delayed communication is a legitimate complaint
  3. Not providing a clinical update: he needs to know what is happening with his mother now

Resitting PLAB 2?

If angry patient stations have caused difficulty, the key is staying calm and not becoming defensive. Practise de-escalation techniques: acknowledge the anger, validate the emotion, and listen fully before offering solutions. Many resitters lose marks by trying to explain or justify too early.

Example opening

Good morning/afternoon, I'm Dr [Name]. I can see you're upset, and I want to understand what has happened so I can help. Please, take your time and tell me what's been going on.

Frequently asked questions

How should I de-escalate and structure this hip fracture (Post-Fall) consultation?

An angry relative requires the same de-escalation approach as an angry patient: listen, acknowledge, then act. Mr Fisher (51) is furious about his 79-year-old mother's care after a fall. She fractured her hip and he feels the team has been negligent.

Where are marks won and lost in this hip fracture (Post-Fall) station?

Examiners reward: Mother's current status conveyed. Treatment plan explained. Communication gap identified. Candidates are penalised for: Not providing clinical update.

Where do candidates most often go wrong in this station?

Being defensive about the team's care: even if care was appropriate, his experience of it was poor.

Can I do well in this station without real-world experience of hip fracture (Post-Fall)?

This station rewards process over personal experience. The skill being assessed: Acknowledging each concern specifically: not a generic 'I am sorry you feel that way'. Work through the consultation approach above, then rehearse it aloud under the 8-minute time pressure so the structure holds up in the exam.

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