PLAB 2 ethics stations: capacity, confidentiality, DVLA and duty of candour

The short version

• Each PLAB 2 scenario lasts eight minutes and is marked in three domains: Data gathering, technical and assessment skills; Clinical management skills; Interpersonal skills [1][2].
• Capacity: start from the presumption that the adult has capacity. An unwise decision is not proof that they lack it. Capacity is about one decision at one time [3][4][5].
• Confidentiality: you can disclose without consent in the public interest if not disclosing may expose others to a risk of death or serious harm [6].
• DVLA: the driver is legally responsible for telling the DVLA. If an unfit driver keeps driving and puts others at risk, you contact the DVLA promptly, tell the patient in writing, and record it [7][8].
• Duty of candour: when something goes wrong with care, tell the person, apologize, offer a remedy or support, and explain the short and long term effects. Apologizing is not admitting legal liability [9].
• A colleague's error: make the patient safe first, be open with the patient, and raise it through the proper route.

Capacity: the Mental Capacity Act 2005

The five principles (section 1)

The Act sets out five principles [3]:

1. A person must be assumed to have capacity unless it is established that they lack capacity.
2. A person is not to be treated as unable to make a decision unless all practicable steps to help them have been taken without success.
3. A person is not to be treated as unable to make a decision merely because they make an unwise decision.
4. An act done or decision made for a person who lacks capacity must be done or made in their best interests.
5. Before acting, consider whether the purpose can be achieved as effectively in a way that is less restrictive of the person's rights and freedom of action.

The test (sections 2 and 3)

A person lacks capacity in relation to a matter if, at the material time, they are unable to make a decision for themselves because of an impairment of, or a disturbance in the functioning of, the mind or brain [4]. They are unable to make a decision if they are unable to [5]:

The GMC's consent guidance says medical professionals must start from the presumption that all adult patients have capacity, that a patient can only be judged to lack capacity to make a specific decision at a specific time, and only after assessment in line with legal requirements, and that the choice of treatment or care for patients who lack capacity must be of overall benefit to them [10].

Confidentiality and the DVLA

The GMC says disclosure without consent can be justified in the public interest if failure to disclose may expose others to a risk of death or serious harm [6]. Fitness to drive is a good example to practice. According to GOV.UK and the GMC guidance on fitness to drive [7][8]:

1. The driver is legally responsible for telling the DVLA about a condition that may affect safe driving.
2. You explain to the patient how the condition may affect their driving and that they have a legal duty to tell the DVLA.
3. If the patient can't understand this (for example because of dementia), you tell the DVLA as soon as practicable.
4. If a patient who is unfit to drive keeps driving, you try to persuade them to stop.
5. If they continue and pose a risk of death or serious harm to others, you contact the DVLA promptly, tell the patient in writing that you have done so, and record it.

The DVLA decides on licensing, not you. In a station, you don't need to quote the exact time off driving for each condition: "You must not drive, and the DVLA will decide when you can drive again" is safe and accurate.

A colleague's error and the duty of candour

The GMC and NMC joint guidance "Openness and honesty when things go wrong: the professional duty of candour" (updated Dec 13, 2024) says that when something goes wrong with a patient's care and it causes, or has the potential to cause, harm or distress, you must [9]:

• tell the person (or, where appropriate, their advocate, carer or family) that something has gone wrong
• apologize
• offer an appropriate remedy or support to put matters right (if possible)
• explain fully the short and long term effects of what has happened

Apologizing does not mean admitting legal liability [9]. The guidance also asks you to be open and honest with colleagues, employers and regulators, and to take part in reviews and investigations [9].

When the error is a colleague's (a wrong dose given, a result missed, a wrong-site mark), a safe order in a station is:

1. Patient safety first: assess the patient, put right what can be put right, and get senior help if needed.
2. Be open with the patient: what happened, an apology, what you are doing about it, what it means for them.
3. Raise it properly: tell your senior, report it through the local incident reporting system, and speak to the colleague directly and without blame.
4. Don't cover it up and don't blame: "These things happen" or "It was the nurse's fault" both cost marks.

Decision table: what to do in common PLAB 2 ethics situations

Practice summary written by Confetto from the sources cited in each row. It is not legal advice.

Worked example: a driver who won't tell the DVLA

Example written by Confetto for practice. It is not a real PLAB 2 station and not a GMC sample.

Candidate instructions (example): You are an F2 doctor in a GP surgery. Mr Tom Brennan, 52, was seen in A&E last week after a first seizure. The hospital letter says he has been advised not to drive and that he should inform the DVLA. He has come for a follow-up. Speak to him.

What the simulated patient knows (hidden): he drives a delivery van for work; he has driven twice since the seizure "just locally"; he hasn't told the DVLA; he is the only earner at home and fears losing his job; he thinks the seizure was "a one-off because I was tired". He will agree to stop if the doctor is clear, honest and helps him think about work, but he becomes defensive if lectured.

The walkthrough

0:00 to 1:30, open and find out what he knows

Doctor: Hello, Mr Brennan, I'm Dr Rahman, one of the doctors here. I've had the letter from the hospital about last week. How have you been since then?

Patient: Fine. It was a one-off. I was exhausted.

Doctor: What did they tell you at the hospital about driving?

Patient: Something about the DVLA. But I need the van for work.

1:30 to 3:30, explore and find the concern

Doctor: It sounds like work is a big worry. Can you tell me more?

Patient: If I can't drive, I can't work. I'm the only one earning. I've had to drive a couple of times already.

Doctor: Thank you for being honest with me. That sounds like a lot of pressure.

3:30 to 5:30, explain the risk and the law

Doctor: After a seizure, there's a risk of another one, and if that happened while you were driving, you or someone else could be seriously hurt or killed. The law says that you must tell the DVLA, and you must not drive until the DVLA says you can. The DVLA makes that decision, not me.

Patient: So you're going to report me?

Doctor: My hope is that you'll tell them yourself, and I'll help you with that. I do need to be honest with you: if you kept driving and I thought other people were at risk, I would have to tell the DVLA myself, and I would let you know in writing first. I'd much rather we sort this together.

5:30 to 8:00, plan and close

Doctor: Can we think about work? Is there anything you could do at your job that doesn't involve driving, while this is sorted? I can give you a fit note if you need time off, and I'd like to make sure your follow-up with the seizure clinic is booked. Would you be willing to contact the DVLA this week?

Patient: I suppose so. I'll do it tonight.

Doctor: Thank you, that's the right thing to do. If you have another seizure, or any seizure lasts more than five minutes, someone should call 999. I'll write in your notes what we've agreed. Can you tell me what you're going to do next?

What scores in each domain (labelled practice breakdown)

Sample breakdown written by Confetto for practice. It is not the GMC marking sheet.

Practice this station

Confetto isn't affiliated with the GMC.