Ethics · Advanced · Medical Error

Laboratory Test Results and Sample Management

Practise this PLAB 2 ethics station on Laboratory Error. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a GP surgery. Ms Monica Davidson, a forty-year-old woman, has come in following a telephone call from the lab regarding an unlabelled blood sample that was discovered during processing. The sample cannot be identified and must be rejected. You must inform her of this error, explain the implications, discuss the need to repeat the tests, and ensure appropriate safety measures are in place.

Background notes: PMH: Hypercholesterolaemia, otherwise fit and well

What this station tests

  • Duty of candour for laboratory errors: honest disclosure even when the error is not clinical
  • Not acting on inaccurate results: repeating before making clinical decisions
  • Acknowledging inconvenience: she took time off work as a single parent
  • Incident reporting through laboratory governance
  • Expediting repeat results to minimise the impact

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 laboratory error affecting patient results requires duty of candour, honest explanation, and a plan to correct the situation. Ms Davidson is 40, called in because her blood results were affected by a laboratory processing error and need repeating. She is anxious. Open with: 'Ms Davidson, thank you for coming in. I need to explain something about your recent blood tests.'

Core approach

Explain what happened. 'There was a problem with the processing of your blood sample in the laboratory. This means the results we received may not be accurate. We need to repeat the tests today to get reliable results.' Be honest: this was a laboratory error, not her fault, and she has not been harmed but the inconvenience and anxiety are acknowledged.

She is a single parent, took time off work to come in, and is now worried about what the original results showed. Address each concern: 'The original results cannot be relied upon, which is why we are repeating them. I would not want to act on inaccurate results.' She may ask whether she was treated based on wrong results: check and confirm.

Duty of candour: the error is disclosed. Incident reported through the laboratory governance process. She should not bear the cost of the repeat visit (time off work).

Closing and safety netting

Repeat bloods today. Results expedited. Follow-up with accurate results as soon as available. If any treatment was based on the erroneous results: review and adjust. PALS if she wants to complain. Apologise for the inconvenience: 'I am sorry you have had to come back. This should not have happened.' Safety net: results communicated promptly. Follow-up: phone call with results.

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: Original results reviewed. Treatment based on them checked. Repeat bloods arranged.

Costs marks: Not checking what was done with original results.

Domain 2 (Primary focus)

Scores well: Repeat bloods. Results expedited. Incident reported. Any treatment based on errors reviewed. PALS offered.

Costs marks: Not repeating. Not reporting. Acting on errors.

Domain 3 (Primary focus)

Scores well: Honest explanation. Apologising. Acknowledging inconvenience (single parent, time off work). Not minimising.

Costs marks: Minimising. Not apologising. Dismissive of inconvenience.

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. Minimising the error: it is inconvenient and anxiety-provoking for the patient
  2. Acting on potentially inaccurate results rather than repeating
  3. Not reporting the incident: laboratory errors require formal governance reporting

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 laboratory error ethics station in PLAB 2?

A laboratory error affecting patient results requires duty of candour, honest explanation, and a plan to correct the situation. Ms Davidson is 40, called in because her blood results were affected by a laboratory processing error and need repeating. She is anxious.

What are examiners marking in this laboratory error station?

Marks are won for: Original results reviewed. Treatment based on them checked. Repeat bloods arranged. Marks are lost for: Not checking what was done with original results.

What is the most common mistake candidates make in this laboratory error station?

Minimising the error: it is inconvenient and anxiety-provoking for the patient. Another frequent error: Acting on potentially inaccurate results rather than repeating.

How do I prepare for this station if I have not managed laboratory error in clinical practice?

This station rewards process over personal experience. The skill being assessed: Not acting on inaccurate results: repeating before making clinical decisions. 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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