Explaining a diagnosis to a patient: chunk and check for PLAB 2
To explain a diagnosis well, find out what the patient already knows, then give the information in small pieces in plain words, checking understanding after each one. NICE's shared decision making guideline (NG197) calls this chunk and check, and recommends teach-back: asking the patient to explain back what was discussed. In PLAB 2, the GMC marks every scenario in three domains, and it lists "explaining something to the patient" under clinical management skills.
Last checked Nov 1, 2026 against the NICE and GMC pages listed under Sources.
The short version
- Start with them. Ask what they know and what they're worried about before you explain anything.
- Chunk and check. NICE NG197 describes breaking information into "smaller, more manageable chunks" and checking understanding before moving on.
- Plain words. Name the condition, then say what it means in everyday language. Avoid jargon, or explain it straight away.
- Options, not orders. NICE NG197 says to discuss the risks, benefits and consequences of each option, including no treatment. The GMC's Decision making and consent guidance covers discussing the benefits and harms of options with patients.
- Teach-back at the end. "To make sure I've explained it well, can you tell me what you'll do now?"
- PLAB 2 has 16 scenarios of eight minutes each, so a typical explanation station leaves about five minutes for the explanation and plan itself (our estimate).
What NICE says about explaining information
NICE's guideline on shared decision making (NG197, 2021) describes shared decision making as a "collaborative process" between a person and their healthcare professional. For explaining information, it recommends:
| NICE NG197 idea | What it means in a consultation |
|---|---|
| Chunk and check | Give information in smaller, more manageable chunks, and check understanding after each one |
| Teach-back | Ask the person to explain back what has been discussed, in their own words |
| Discuss every option | Talk about the risks, benefits and consequences of each option, including no treatment |
| Use absolute risk and natural frequencies | "About 1 in 100 people" is easier to understand than "a 50% relative risk reduction" |
The GMC's Decision making and consent guidance (in effect since November 2020, updated in August 2026) also covers the information you give patients, including discussing the benefits and harms of their options.
A structure for any explanation station
- Introduce yourself and check who you're speaking to.
- Find out what they know: "What have you been told so far?" / "What do you understand about why we did the test?"
- Ask about their ideas and concerns if you don't already know them.
- Signpost: "I'd like to explain what the test showed, what it means, and what we can do. Is that OK?"
- Name the diagnosis clearly, once, in plain words.
- Chunk 1, what it is. Pause. Check.
- Chunk 2, why it happens. Pause. Check.
- Chunk 3, what it means for them (and answer their concern). Pause. Check.
- Chunk 4, the options and the plan. Agree it together.
- Safety-net and arrange follow-up.
- Teach-back. Offer written information.
Worked example: a new diagnosis of type 2 diabetes
Example written by Confetto for practice (not a real exam station). Clinical content is kept general; follow current NICE/CKS guidance in real practice. No doses are given on purpose.
Candidate instructions: You are an F2 in general practice. Mr. Imran Qureshi, 52, had a routine blood test. His HbA1c result confirms type 2 diabetes. Explain the diagnosis and discuss the next steps.
Doctor: Hello Mr. Qureshi, I'm Dr. Evans, one of the doctors here. Thanks for coming in. What do you understand about why we did the blood test?
Patient: The nurse said my sugar might be a bit high.
Doctor: That's right. Have you had any thoughts about what it might mean?
Patient: My mum had diabetes. She lost her leg in the end. I'm worried it's that.
Doctor: I'm sorry about your mum. That must make this worrying. I'd like to explain what the test showed and what we can do about it, and I'll come back to that worry. Is that OK?
Patient: Yes.
(Chunk 1: what it is)
Doctor: The test shows you have type 2 diabetes. That means the sugar level in your blood is higher than it should be. Does that make sense so far?
Patient: I think so.
(Chunk 2: why)
Doctor: Normally, a hormone called insulin helps move sugar from your blood into your body's cells for energy. In type 2 diabetes, your body doesn't respond to insulin as well as it should, so sugar builds up in the blood. Can I check that's clear?
Patient: So my body isn't using the sugar properly.
Doctor: Exactly.
(Chunk 3: what it means, and the concern)
Doctor: You mentioned your mum. Over many years, high sugar can damage blood vessels and nerves, including in the feet. That's why we take it seriously. The good news is that finding it now means we can lower your sugar and check your feet, eyes and kidneys regularly, to catch any problem early. How does that feel to hear?
Patient: Better than I thought, to be honest.
(Chunk 4: options and plan)
Doctor: There are a few parts to treatment: changes to diet and activity, which make a big difference; a course to learn about living with diabetes; and often a tablet to help lower the sugar. We'd also check your blood pressure and cholesterol. What do you think about those options?
Patient: I'd like to try the diet first, but I'll take the tablet if I need it.
Doctor: That's reasonable, and we can talk it through with the nurse. If you get very thirsty, are passing urine a lot more than usual, or feel very unwell, please contact us the same day.
(Teach-back)
Doctor: To make sure I've explained it well, could you tell me in your own words what diabetes is and what we've agreed?
Patient: My sugar's too high because my body doesn't use insulin properly. I'm going to change my diet, see the nurse, and you'll check my feet and eyes.
Doctor: Perfect. I'll give you a leaflet too.
Sample marking breakdown (example written by Confetto, not an official GMC mark sheet)
| Domain (GMC) | What the candidate did | Missed opportunities that would cost credit |
|---|---|---|
| Data gathering, technical and assessment skills | Checked what he knew; found his idea (high sugar) and concern (his mum's amputation) | Not asking what he knew; never finding the concern |
| Clinical management skills (the GMC lists "Formulating a diagnosis, explaining something to the patient, formulating a management plan") | Correct diagnosis explained clearly, sensible first steps, regular checks, offered options, safety-netting | Prescribing without discussion; no follow-up; no safety net |
| Interpersonal skills | Plain words, chunk and check, answered the concern, shared decision, teach-back | Jargon ("glycemic control", "HbA1c of…" with no explanation); a monologue with no checks |
The GMC doesn't publish station-level mark sheets. This breakdown shows where each behavior fits in the published domains.
Jargon to plain English
Use the plain words with patients. Use the clinical words with the examiner, colleagues and in notes.
| Medical term | Plain English |
|---|---|
| Hypertension | High blood pressure |
| Myocardial infarction | Heart attack |
| Angina | Chest pain caused by the heart not getting enough blood |
| Cerebrovascular accident / CVA | Stroke |
| Type 2 diabetes mellitus | A condition where the sugar level in your blood is too high |
| HbA1c | A blood test that shows your average sugar level over the last few months |
| Benign | Not cancer |
| Malignant / neoplasm | Cancer |
| Lesion | An area that looks different or damaged |
| Biopsy | Taking a small sample of tissue to look at under a microscope |
| Chronic | Long-term |
| Acute | Sudden, or short-term |
| Renal | To do with the kidneys |
| Hepatic | To do with the liver |
| Edema | Swelling caused by fluid |
| Dyspnea | Breathlessness |
| Fracture | A break in the bone (some people think a fracture is less serious than a break: it's the same thing) |
| Analgesia | Pain relief |
| Prognosis | What is likely to happen in the future |
| Idiopathic | We don't know the cause |
| "Positive" result | Say what it means: "The test shows you have…" (patients can hear "positive" as good news) |
| "Negative" result | "The test didn't show any sign of…" |
Common mistakes
| Mistake | Better |
|---|---|
| Starting the explanation before asking what they know | One question first: "What have you been told so far?" |
| A two-minute monologue | Three or four short chunks, with a check after each |
| "Do you understand?" (they'll say yes) | "Can you tell me in your own words…?" |
| Using a medical word without explaining it | Name it, then explain it straight away |
| Ignoring the patient's concern | Name it and answer it in your explanation |
| Telling, not offering | Explain options, including doing nothing, and ask what they prefer |
| Forgetting safety-netting and follow-up | Always end with what to watch for and when you'll meet again |
Practice this station
Confetto isn't affiliated with the GMC.
Frequently asked questions
What is "chunk and check"?
Giving information in small pieces and checking the person has understood each one before moving on. NICE's shared decision making guideline (NG197) recommends it.
What is teach-back?
Asking the patient to explain back, in their own words, what you've discussed. It checks your explanation, not their intelligence. NICE NG197 recommends it.
How is an explanation station marked in PLAB 2?
Like every PLAB 2 scenario, in three GMC domains: data gathering, technical and assessment skills; clinical management skills, which the GMC says includes "explaining something to the patient"; and interpersonal skills. The GMC doesn't publish station-level mark sheets.
Should I use medical terms at all?
Name the condition so the patient can look it up and recognize it later, then explain it in plain words straight away. Avoid other jargon.
How do I explain risk to a patient?
NICE NG197 recommends using absolute risk and natural frequencies, such as "about 1 in 100 people", rather than percentages or relative risk.
Is this useful for the SCA too?
Yes. The RCGP's SCA toolkit includes "Verbalises diagnosis and/or analysis" under relating to others and "Uses clear language" as a global skill. See our SCA marking guide.
Sources
Read on November 1, 2026.