Apologising for a prescribing error — duty of candour
PLAB 2 & PRES 3 · nephrology / communication · hard · 10 minutes
Candidate brief
You are an FY2 doctor on an acute medical ward. Ten days ago, in a general medical clinic, you prescribed ibuprofen 400 mg three times daily for knee pain to Mrs Kathleen O'Brien, 72. She has chronic kidney disease stage 3 and takes lisinopril — a combination that makes non-steroidal anti-inflammatory drugs risky for the kidneys. Four days later her GP's blood tests showed an acute kidney injury (her creatinine had doubled), and she was admitted to your ward. The ibuprofen has been stopped, she has had intravenous fluids, and after five days her kidney function is improving but is not yet back to baseline. Your consultant has asked you to speak to Mrs O'Brien, who does not yet know the reason for her admission in full. Please explain what happened, apologise, and discuss what happens next.
What examiners look for
Candour is a sequence: what happened, that it was an error, that it was yours, what it caused, sorry, what changes. Candidates fail this station by scrambling the order — apologising vaguely before any facts, or drowning the apology in pharmacology. She asked one question at the door: what happened to my kidneys? Answer it first, in the first person. The passive voice is the tell. "An error occurred" and "the prescription was written" are grammatically fine and morally empty. Examiners listen for "I prescribed" — ownership is the entire point of the professional duty of candour, and it is what patients later say made the difference. Do not ask the harmed person to comfort you. "I feel terrible about this" invites her to reassure the doctor who injured her, which patients — especially of her generation — will politely do, at their own expense. Remorse is shown by thoroughness, follow-through and honesty about consequences, not by visible suffering. System factors are true and still not a shield. Alerts, workload and pharmacist checks belong in the explanation when she asks "why did nothing stop you?" — as facts about how the review will improve things, never as the answer to "was it your fault?" The prescriber's signature is the prescriber's responsibility, and she already knows it. Prognosis must land between the two lies: "they'll definitely recover fully" and dark vagueness that leaves her picturing dialysis. Recovering well, likely substantial recovery, monitored, dialysis not expected — each clause earns its place, and naming the dialysis fear she has not yet voiced is what turns information into relief. Close the loop on the original problem. She came with a painful knee and leaves with injured kidneys and a painful knee unless you build her a safe plan — alternatives, the over-the-counter warning, and follow-up. The forgotten presenting complaint is the signature of a disclosure done for the doctor, not the patient. A complaint welcomed is trust rebuilt. Telling her, unprompted, that she may complain, that it changes nothing about her care, and that her nurse daughter is welcome in the conversation is not generosity — it is the duty of candour working as designed, and it is usually what makes patients decide not to.
Guideline references
- https://geekymedics.com/explaining-a-medical-error-osce-guide/
- https://www.gmc-uk.org/-/media/documents/openness-and-honesty-when-things-go-wrong--the-professional-duty-of-candour-61540594.pdf
Practise this station
Role-play it with an AI patient and get feedback against the full marking scheme. Create a free account — 3 stations per month free.