How to Explain a Diagnosis in PLAB 2 Without Jargon

You’ve just taken a history, examined the patient, and reached a diagnosis. Now you have to explain it in a way the patient understands—without jargon, without overwhelming them, and within the 8-minute PLAB 2 station. The examiner is marking three domains: data gathering, clinical management, and interpersonal skills. A poor explanation can lose marks in all three, even if your diagnosis is correct. Here’s how to do it right, with worked examples and exact phrases to use in the station.

Start by chunking the information into small, digestible pieces. After each chunk, check the patient’s understanding before moving on. This isn’t just about being polite—it’s about ensuring the patient actually grasps what you’re saying. Use plain-language swaps for medical terms (e.g., "high blood pressure" instead of "hypertension"), and avoid vague phrases like "we’ll run some tests"—be specific. If the patient nods but doesn’t ask questions, they may not have understood. Use teach-back: ask them to explain it back to you in their own words. This isn’t patronising; it’s good practice.

Chunk-and-Check: The Framework

1. Name the diagnosis in plain language – Don’t assume the patient knows what "angina" or "gastro-oesophageal reflux" means. Start with a simple label: "The chest pain you’re describing is called angina." Pause. Check: "Does that term mean anything to you?"

2. Explain what it is – One sentence, no jargon. For angina: "It’s a warning sign that your heart isn’t getting enough blood when you’re active or stressed." Pause. Check: "Does that make sense so far?"

3. Explain why it’s happening – Again, one sentence. For angina: "The arteries that supply blood to your heart have become narrower over time, usually because of fatty deposits." Pause. Check: "Do you follow what I’m saying?"

4. Explain what happens next – Be specific about investigations, referrals, or treatments. For angina: "We’ll need to do a heart tracing (ECG) today and arrange a scan of your heart’s blood vessels. You’ll also need some tablets to help with the pain and protect your heart." Pause. Check: "What questions do you have about that?"

5. Safety-net – Tell them what to do if things get worse. For angina: "If the pain happens at rest or lasts more than 10 minutes, call an ambulance immediately."

6. Teach-back – Ask them to summarise: "Just so I know I’ve explained it clearly, can you tell me in your own words what angina is and what we’re going to do next?"

Plain-Language Swaps for Common Terms

Avoid euphemisms like "a touch of sugar" for diabetes—it trivialises the condition. Similarly, don’t say "a bit of arthritis" if the patient has severe osteoarthritis. Be honest but clear.

Before and After: A Worked Example

Scenario: A 55-year-old man with exertional chest pain. Diagnosis: stable angina.

Before (Jargon-Heavy, No Checks): Doctor: "Your symptoms are consistent with stable angina, likely due to atherosclerotic coronary artery disease. We’ll need to do an ECG and refer you for an angiogram. You’ll also need GTN spray for symptom relief and secondary prevention with aspirin, a statin, and possibly a beta-blocker." Patient: [Nods blankly] "Okay, doctor."

After (Chunk-and-Check, Plain Language): Doctor: "The chest pain you’re describing is called angina. It’s a warning sign that your heart isn’t getting enough blood when you’re active or stressed. [Pause] Does that term mean anything to you?" Patient: "Not really, no." Doctor: "That’s fine. It happens because the arteries supplying blood to your heart have become narrower over time, usually because of fatty deposits. [Pause] Does that make sense so far?" Patient: "Yes, I think so." Doctor: "Good. We’ll need to do a heart tracing today—it’s a quick test where we stick some stickers on your chest to check your heart’s electrical activity. We’ll also arrange a scan to look at the blood vessels around your heart. You’ll need some tablets to help with the pain and protect your heart long-term. [Pause] What questions do you have about that?" Patient: "Will I need an operation?" Doctor: "Not necessarily. Many people manage well with tablets and lifestyle changes. If the scan shows severe narrowing, we might discuss a procedure to widen the arteries, but we’ll cross that bridge if we come to it. [Pause] Can you tell me in your own words what angina is and what we’re going to do next?" Patient: "So it’s when my heart doesn’t get enough blood because the pipes are clogged. You’ll do a heart tracing today and a scan later, and I’ll start some tablets." Doctor: "Exactly right. If the pain happens at rest or lasts more than 10 minutes, call an ambulance straight away."

Handling Common Patient Reactions

"Is it cancer?" – If the diagnosis isn’t cancer, reassure them directly: "No, this isn’t cancer. It’s [plain-language diagnosis]." If it is cancer, don’t lie, but don’t dump the diagnosis on them in the first sentence. Start with: "I’m afraid the tests show something serious, and I need to talk to you about it. Would you like someone with you for this conversation?"

"Will I die?" – Be honest but reassuring. For angina: "Angina isn’t a heart attack, and it doesn’t mean you’re about to have one. But it is a sign that we need to take action to protect your heart. With the right treatment, many people live full lives with angina."

"Can I still drive/work/travel?" – Know the public-interest disclosures. For example, if the patient has epilepsy, you must advise them not to drive and to inform the DVLA. Say: "For your safety and others’, you shouldn’t drive until your seizures are under control. You’ll need to let the DVLA know—it’s a professional duty of mine to tell you that." For angina: "You can drive as long as your symptoms are stable. If you get chest pain while driving, pull over and use your GTN spray."

"I don’t want tablets." – Explore their concerns: "What worries you about taking tablets?" If they’re concerned about side effects, explain: "The tablets I’m suggesting are very safe and have been used for years. The benefits far outweigh the risks." If they’re still resistant, say: "I understand you’d prefer not to take tablets, but this is an important part of managing your condition. Can I suggest we try them for a month and see how you get on?"

What the Examiner Wants to See

• Data gathering: You’ve taken a history and examined the patient, leading to a diagnosis. The explanation flows naturally from this.
• Clinical management: You’ve outlined a clear plan (investigations, referrals, treatments) and safety-netted appropriately.
• Interpersonal skills: You’ve used plain language, checked understanding, and responded to the patient’s concerns. The patient leaves the station feeling informed, not confused or overwhelmed.

The examiner isn’t looking for a perfect script—they’re looking for a doctor who communicates clearly and compassionately. If you chunk the information, check understanding, and use plain language, you’ll score well.

Practice Makes Perfect

Explaining a diagnosis is a skill, and like any skill, it improves with practice. Use platforms like OSCEPilot to run through mock stations with feedback on your communication. Record yourself explaining a diagnosis to a friend or colleague, then listen back—would you understand it if you were the patient?

FAQ

"How much detail should I give in the explanation?" Enough to inform, not overwhelm. Stick to the key points: what the diagnosis is, why it’s happening, what happens next, and what the patient should do if things get worse. If the patient asks for more detail, provide it—but don’t assume they want or need it.

"What if the patient interrupts with questions?" Let them. It’s a good sign—they’re engaged. Answer their question, then return to your explanation. Say: "That’s a really important question. [Answer it.] Where was I? Oh yes, [pick up where you left off]."

"Should I use diagrams or drawings?" Only if it helps. In PLAB 2, you won’t have access to props, so don’t rely on them. If you do draw something, keep it simple and explain it as you go: "This is your heart. These are the blood vessels. They’ve become narrower, which is why you get pain when you walk."