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  • Writer's pictureDeniz Eroglu

Plab 2: “Interpersonal Skills” and “Scripts”




Study plan for Plab 2 varies from person to person depending on their personal circumstances. Plab 2 is majorly about communication skills and discovering the ability to sugar coat and handle patients with care. Some have it naturally in them while others struggle with it. But eventually you will learn to fake it till you make it.


I want to clarify two commonly spoken terms to help everyone understand what they really mean and also to solve misconceptions regarding them (I will support with examples so that it’s easier to understand):



1. IPS:


IPS or interpersonal skills simply means showing empathy and sympathy to the patient. You are reflecting the patient, you are acknowledging their feelings and making them feel that you are there for them. Let me give you some examples:


For instance, if the patient says "Doctor I am worried that I might have cancer". Now, the patient said "worried", it's time to reflect. "Well, I can see that you are concerned about cancer but is there any particular reason why?" This way the patient feels that you are Acknowledging them.


Let's try another one, "Doctor am I going to die?". This is a very common question patients shoot at you, so make sure to reflect. "I am sorry that you feel this way, well you are in good hands and we will do everything in our power to help you get better"

This is just an example, use your own unique and buttery lines to make the patient feel like you are really there for them.


In cases like angry patients, first de-escalate the situation. Do you know what's the best way to do it? Listening. Yes, just listen to the patient, let them take out their frustration, meanwhile you can use that time to cook up some juicy IPS lines but don't forget to actively listen cause if you ask something they already answered it might give them a wrong impression that you are not bothered.


In medical error, it's a solution based approach. First break it in layers and let the patient react. Then, apologise and say something immediately about how seriously the medical team is handling this situation. "I understand the inconvenience caused to you and I deeply apologise for what happened but let me tell how seriously we are handling this situation, we have already taken measures to help you. Would you like to know what has been done"

This way you are making them feel that they are not neglected. Make them feel that they are the top priority and you are only there to cater their needs.


Always be solution oriented. Use the “However technique” (it’s something I came up from listening to a couple of candidates). It’s a technique to help you move forward in an uncomfortable conversation. “Rob I can sense that you are very worried about your mother’s health however there are a few things we can do to help you (support) and your mother (medications/general advice) from our side, would you like me to tell you?”. Another example: “Ashley I am terribly sorry about the inconvenience you had to face with us, however let me reassure you that I have already escalated this to the highest authority and have taken steps to correct our mistake.”


In refusal, I always follow a structure called: Acknowledge, ask Why and offer Solution. "I don't want to take the medications". "I understand that you are not keen on taking the meds but is there any particular reason why?". [Acknowledge and ask why, then give solution]. If still not convinced repeat it. Acknowledge and ask why, then give solution.


Make sure that you always manage to have a two way conversation. I cannot stress this enough. Especially in counselling, ethics and in the management part of medicine cases. You need to check if the patient is following you and understanding what you are saying. Imagine being a simulator, you listen to so many Plab 2 students, if you keep talking for more than 2-3 lines without checking on them, they probably have dozed off with their eyes open.


Involve the patient in everything, explain why, don't enforce anything on the patient. "We would like to keep you in the hospital as it is very important to treat your chest infection right away, is that alright with you?. I will involve my senior to see if we can run a specialised scan called a CT scan which will help us to find the source and extent of the infection. Meanwhile we can start you on some antibiotics through your blood vessels according to the hospital protocol, how does that sound? . If the symptoms don't improve we can refer you to a chest specialist called pulmonologist, would you like to know what they can do for you?. And Mr. Rob, at any time you feel unwell, if you have severe chest pain, blood in your sputum, or a high temperature please do press the button next to you, we will be there right away to help you.”


If the patient has too many concerns take it step by step, don't freak out. "Well, I can see you have a lot on your mind, how about you tell me what's bothering you the most and we can take it from there?"


Last tip, don't ever forget ICE! (Idea, concern and expectation). This is the core of every station.


Everything has an approach. You can make your own unique one as well. Just make sure it is patient centred.


2. BEING SCRIPTED:


Everyone says avoid being scripted, now how do we do that? It's hard to not be scripted because every case has a particular set of questions and a management plan. You need to know what questions to ask and the treatment/solutions for the stations but, what makes you different is how you portray your knowledge.


There are a few things worth mentioning:


You shouldn't throw random lines in between that make no sense. If the patient says he has pain but it's only a grade 3 pain, you don't have to say I am really sorry, I can see that you are in a lot of pain. Don't throw IPS phrases at random places. Use it at the right time. Don't ask patient’s permission to ask questions. "Mr Rob, is it okay if I ask you a few lifestyle questions?".

No.

"Mr Rob, I will now be asking a few lifestyle questions". That's all you need to say and carry on.


Don't signpost unnecessarily as well. I have seen some people signpost for lifestyle. They say something like "I will be asking a few questions that might sound a little personal or intrusive so please bear with me, it's part of the consultation". This wastes too much time and is completely unnecessary. Sign post if the questions are embarrassing like about sexual health or alarming like cancer.


Transition smoothly, don't ignore the patient's concern. The patient might say that they are worried that their tiredness is due to diabetes. Acknowledge, reflect and do make them realise that their concern is valid and that you will get back to them. Don't say I can see you are worried about diabetes and then carry on with your questions. "Well Mr. Rob, that's a very valid concern, may I know why are you worried about diabetes in particular?". "Doctor my wife has diabetes so I am worried I might have it too". "I now understand where you are coming from, don't worry I will definitely address it in a moment but before that I just have a few questions". Or "I now understand where you are coming from, let me ask you some symptoms related to diabetes and see if you have any of them"

This is what I mean by transition smoothly.


Lastly, don't be monotonous. Reflect with the patient. If they are sad, lower your voice and be gentle. If they are happy, be excited for them. If they are angry, listen to them and give them the puppy eyes.


These are small things but very important. Cause if you say phrases blindly without knowing why you are saying them that's when they realise you are a robot.


Need more help and advice?


Trewlink has many excellent posts on PLAB 2 tips by my colleagues which I highly recommend. We have our own PLAB 2 course as well, make sure to check it out!


I hope these tips help you ace the exam! If you have any questions about PLAB 2, I would be happy to answer them at Trewlink.com. Find me as an Ambassador and follow my profile – Premsai Chilakuluri to receive regular support and advice.


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