Ethics · Advanced · Ethics

Parental Concerns: Confidentiality and Contraception

Practise this PLAB 2 ethics station on Confidentiality (Young Person). 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in primary care. Mrs Aruna Bhatt has called requesting an urgent appointment to discuss concerns about her 16-year-old daughter Lucy's use of oral contraceptives. Mrs Bhatt is angry and says Lucy is too young, that the GP should not be prescribing contraception without parental knowledge, and that she wants to speak with you about her concerns. Lucy is NOT present at this consultation. Please manage the consultation sensitively, address maternal concerns, explain confidentiality and Fraser/Gillick competence, and discuss how to support both Lucy and her mother appropriately.

Background notes: PMH: Nil significant

What this station tests

  • Gillick competence at 16: the right to confidential medical care including contraception
  • Cannot confirm or deny whether Lucy is a patient or what has been prescribed
  • Encouraging family communication: the solution is for mother and daughter to talk
  • Safeguarding exception: if the partner is an adult or there is exploitation, confidentiality may be overridden
  • Framing contraception positively: she is being responsible about her sexual health

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself. Establish the ethical issue and your role.
  • 1-3 min — Explore Perspective: Listen to patient/relative perspective. Understand their reasoning and concerns.
  • 3-5 min — Ethical Framework: Apply ethical principles: autonomy, beneficence, non-maleficence, justice. Reference relevant guidelines (GMC, Mental Capacity Act).
  • 5-7 min — Negotiate and Plan: Find common ground. Explain your professional obligations. Involve MDT where appropriate. Document plan.
  • 7-8 min — Closing: Summarise agreed position. Outline next steps. Offer further discussion.

Consultation approach

The opening

A parent requesting confidential information about their child's contraception tests whether the candidate understands Gillick competence and confidentiality for young people. Mrs Bhatt is 48, calling urgently because she found contraceptive pills in her 16-year-old daughter Lucy's bag. Open with: 'Mrs Bhatt, I can hear you are upset. Tell me what has happened.'

Core approach

Listen to her concern. She is angry, frightened, and feels betrayed that Lucy did not tell her. She wants to know: did Lucy get the pills from this surgery? Is she sexually active? Who prescribed them?

Explain confidentiality gently but firmly. 'Mrs Bhatt, I understand your concern as a mother. However, Lucy is 16, and at this age she has the right to confidential medical care, including contraception. I cannot confirm or deny whether she is a patient here or what has been prescribed for her.' This applies even though the mother is asking.

Gillick competence: young people who are assessed as competent can consent to treatment without parental knowledge. Breaking this confidentiality would prevent young people from seeking healthcare. Frame it constructively: 'The fact that she has contraception means she is being responsible about her sexual health.'

Closing and safety netting

Encourage family communication. 'The best person to discuss this with is Lucy. I would encourage you to have an open conversation with her. If you would both like to come in together, I am happy to facilitate that.' Offer a family appointment. Do not break Lucy's confidentiality regardless of the mother's distress.

If there is a safeguarding concern (is Lucy's partner an adult? Is she being exploited?): this would change the confidentiality position. Ask: 'Is there anything about Lucy's relationship that concerns you beyond the contraception itself?' Follow-up: offer appointment for Mrs Bhatt's own anxiety.

How examiners mark this station

Examiners will assess your ethical reasoning and interpersonal skills. Domain 2 (Clinical Management) is primary: marks for applying an ethical framework, referencing relevant legislation and guidelines, and reaching a reasoned position. Domain 3 (Interpersonal Skills) is equally weighted: marks for non-judgmental exploration, empathic communication, and negotiation skills. Domain 1 (Data Gathering) assesses your ability to fully explore the situation before forming a view.

Domain 1 (Supporting)

Scores well: Safeguarding concern checked. Mother's specific worries explored. Relationship context assessed.

Costs marks: Not checking safeguarding.

Domain 2 (Primary focus)

Scores well: Confidentiality maintained. Gillick competence explained. Family appointment offered. Safeguarding assessed.

Costs marks: Breaking confidentiality. Not knowing Gillick.

Domain 3 (Primary focus)

Scores well: Empathic with the mother. Firm but kind about confidentiality. Encouraging communication. Not judging either party.

Costs marks: Dismissive. Breaking confidentiality. Being judgmental about Lucy.

Common examiner feedback (and how to fix it)

Did not demonstrate adequate ethical reasoning or application of relevant guidelines

Fix: Structure your response around the four ethical pillars (autonomy, beneficence, non-maleficence, justice). Reference specific guidelines (GMC, Mental Capacity Act) where relevant.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Acknowledge the emotional weight of the situation early. Show that you understand why this is difficult before applying ethical reasoning.

Common mistakes in this station

  1. Breaking confidentiality: confirming Lucy's contraception to her mother violates Gillick competence
  2. Being dismissive of the mother's concern: she is worried, and her feelings are valid even though you cannot share information
  3. Not checking for safeguarding: is the partner age-appropriate? Is there any exploitation?

Resitting PLAB 2?

If you have found ethics stations difficult, focus on learning a clear ethical framework (the four pillars) and practising how to apply it conversationally rather than reciting principles. Examiners reward candidates who can explore the tension between competing ethical principles while remaining empathic and non-judgmental.

Example opening

Thank you for coming in to speak with me. My name is Dr [Name]. I understand there is something important we need to discuss. Could you tell me your understanding of the situation?

Frequently asked questions

How should I approach this confidentiality (Young person) ethics station in PLAB 2?

A parent requesting confidential information about their child's contraception tests whether the candidate understands Gillick competence and confidentiality for young people. Mrs Bhatt is 48, calling urgently because she found contraceptive pills in her 16-year-old daughter Lucy's bag.

What are examiners marking in this confidentiality (Young person) station?

Marks are won for: Safeguarding concern checked. Mother's specific worries explored. Relationship context assessed. Marks are lost for: Not checking safeguarding.

What is the most common mistake candidates make in this confidentiality (Young person) station?

Breaking confidentiality: confirming Lucy's contraception to her mother violates Gillick competence. Another frequent error: Being dismissive of the mother's concern: she is worried, and her feelings are valid even though you cannot share information.

How do I prepare for this station if I have not managed confidentiality (Young person) in clinical practice?

Structure beats experience here. Focus on cannot confirm or deny whether Lucy is a patient or what has been prescribed. 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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