PLAB 2 telephone stations: what changes when you can’t examine

You’re on the phone with a patient you can’t see or touch. The PLAB 2 examiner is watching how you compensate: safety-netting becomes your stethoscope, and every word you choose must do the work of inspection, palpation, and percussion. You are still marked on the same domains, but without an examination to lean on, your history, communication and safety-netting have to carry the station. That means if you miss a red-flag symptom because you didn’t ask the right question, or if you fail to document a clear follow-up plan, you’ll drop from a pass to a fail regardless of how slick your history was.

Start by anchoring the call: confirm the patient’s name, date of birth, and the number you’re calling from. Say, “I’m Dr X, one of the doctors at Y Surgery. I’m calling about your results. Is now still a good time to talk?” This 15-second script buys you two things: consent and context. If the patient sounds breathless or distracted, you’ve already picked up a verbal cue that would have been obvious in person. Next, signpost the structure: “I’ll ask a few questions, then explain what I think is going on and what we’ll do next.” Patients on the phone can’t see your body language, so they rely on verbal roadmaps to stay oriented.

Verbal cues that replace visual ones

In a telephone station, the examiner will feed you auditory cues—tone, pauses, sighs, background noise. Train yourself to hear them. A patient who says, “I’m fine,” but pauses for three seconds before answering is not fine. Mirror the pause: “You hesitated there—is there something else?” If they mention “a bit of a cough,” probe for red flags: “When you say ‘a bit,’ does it wake you at night? Bring up any blood or phlegm?” Use the same systematic enquiry you would in clinic, but make it conversational. For respiratory symptoms, ask: “Can you take a deep breath for me now? Does it hurt anywhere?” You may hear audible wheeze or stridor, but that is limited: crackles cannot be reliably assessed by telephone, and splinting is not an auditory finding. Do not present telephone listening as an examination.

For abdominal pain, ask the patient where it hurts most: “Use one finger and press where it hurts most.” If they say “right here,” follow with, “Is that above or below your belly button?” and “Does pressing make it worse?” That gathers the patient’s own report of tenderness, which is not the same as eliciting Murphy’s sign or McBurney’s point. For neurological symptoms, do not try to assess gait, ataxia or foot-drop by listening — those need video or face-to-face assessment, so escalate to an in-person review if they are relevant.

Safety-netting: the new physical examination

Safety-netting in telephone stations isn’t a box-ticking exercise—it’s your only way to mitigate risk. The examiner wants to see you’ve considered the worst-case scenario and given the patient clear instructions on what to do if things deteriorate. For a 35-year-old with a two-day history of diarrhoea, say: “Most cases settle on their own, but if you see blood, can’t keep fluids down, or feel dizzy when you stand, call 111 straight away. If you’re not improving by tomorrow evening, phone the surgery before 10 a.m. and we’ll arrange a face-to-face review.” Notice the specifics: timeframe, symptoms, and exact next step. Vague advice like “come back if you’re worried” scores zero.

For children, safety-netting must include the parent’s understanding. After explaining a viral rash, ask: “What will you do if the rash spreads or your child becomes floppy?” If they can’t repeat the red flags, you haven’t safety-netted. For mental health calls, document a crisis plan: “If you feel you can’t keep yourself safe, go to A&E or call 999. If there is no immediate risk, contact the local crisis team or NHS 111 (option 2 for mental health).”

Documentation phrases that pass

Your notes must stand alone—another clinician should be able to pick them up and know exactly what you did and didn’t do. Use these exact phrases:

• “Telephone consultation: patient confirmed identity, consented to discussion.”
• “Auditory examination: no stridor, no wheeze on deep inspiration.”
• “Safety-netted: advised to call 111 if symptoms X, Y, Z develop within 24 h.”
• “Follow-up: face-to-face review booked for [date/time] if no improvement.”

Avoid shorthand like “Pt ok.” Instead, write: “Patient reports resolution of symptoms, understands safety-netting advice, no further concerns voiced.” The examiner will check your notes against the mark scheme; if you’ve missed a key phrase, you’ve missed the mark.

The 90-second checklist you run before ending the call

1. Red flags: “Have you had any chest pain, shortness of breath, or blackouts?”
2. Understanding: “What’s your main worry about this?”
3. Safety-netting: “What will you do if [specific symptom] happens?”
4. Follow-up: “When should you call us back?”
5. Documentation: “I’ll write this up now and send a copy to you.”

Run this checklist aloud in every telephone station. It takes about a minute and covers the points examiners look for in communication and safety-netting. If you forget a step, the examiner will assume you’d forget it in real practice.

Common pitfalls and how to avoid them

• Assuming the patient is alone: Ask, “Is anyone with you who can help?” If a carer is present, involve them in safety-netting.
• Ignoring background noise: If you hear a child crying, ask, “Is your child unwell too?” The examiner may be testing whether you pick up on household context.
• Rushing the close: End with, “Is there anything else you’d like to ask?” Patients often save their biggest worry for last.

When to escalate to face-to-face

The rule of thumb: if you’d want to examine the patient in clinic, you should see them in person. Say: “I’d like to check your blood pressure and listen to your chest. Can you come in today?” For children under five with fever, always offer a same-day appointment. For mental health, if there is imminent risk, take immediate emergency action; for other urgent presentations, arrange urgent same-day face-to-face assessment. Document your reasoning: “Telephone assessment limited; patient’s flat affect and tangential speech raise concern for depressive psychosis—urgent review indicated.”

Practising for the real thing

Telephone stations feel unnatural because you’re acting without visual feedback. Record yourself on your phone, play it back, and count how many times you say “okay” or “right.” If it’s more than three, you’re filling silence instead of listening. OSCEPilot’s AI-powered mock stations let you practise with realistic patient responses and instant feedback on your safety-netting and documentation.

FAQ

Q: How long should a PLAB 2 telephone station last? A: The station is eight minutes, but your actual call should last five to six minutes. Keep the last minute for summarising and safety-netting. If you reach the last minute and haven’t safety-netted yet, stop and do it now: an incomplete plan costs more than an unfinished history.

Q: What if the patient doesn’t answer my safety-netting questions? A: Repeat the advice and ask them to summarise: “Just so I know you’ve got this, what will you do if you feel worse?” If they still can’t answer, document: “Safety-netting advice given but not retained—face-to-face review arranged.”

Q: Can I use a template for documentation? A: Yes, but adapt it. A generic template like “Telephone consultation re: [symptom]” is fine, but you must add specifics: “Auditory examination: no stridor, no wheeze on deep inspiration. Safety-netted: advised to call 111 if breathless or chest pain develops.” The examiner wants to see you’ve tailored the note to the patient, not just filled in blanks.