Breaking bad news — colorectal cancer diagnosis
PLAB 2 & PRES 3 · oncology / communication · hard · 10 minutes
Candidate brief
You are an FY2 doctor working in a colorectal outpatient clinic. Mr David Whitfield, 63, had a colonoscopy two weeks ago after blood tests showed iron-deficiency anaemia and he reported a change in bowel habit. The biopsy result from a sigmoid colon lesion has returned: adenocarcinoma of the colon. His staging CT scan has been requested but not yet performed. He has attended today expecting a routine result and believes the problem is "probably just polyps". Please break the news of the diagnosis to him and discuss the next steps.
What examiners look for
Perception before information. His opening line — "just the polyp results" — is the station telling you the gap you must cross. Ask what he expects, then use a warning shot to narrow the gap before the diagnosis lands; patients remember almost nothing said in the ten seconds after the word cancer, so spend nothing important there. Say "cancer". Every euphemism you substitute ("a growth", "a tumour that could be serious") buys you comfort and costs him clarity — and examiners, like patients, mark the doctor who cannot say the word as not having broken the news at all. The pause after the diagnosis is not dead air; it is the consultation. Sit in it. The candidate who fills it with chemotherapy details is treating their own discomfort. Wait until he speaks, and let his first question set the agenda. Honesty about uncertainty is a skill, not a gap in knowledge. "The biopsy is certain; the spread is not known until the scan" gives him two solid handholds. Invented precision — percentages, promises, "we've caught it early" — feels kind and is a professional failure: he will repeat your words to his family as fact. Feelings of wellness are not evidence to argue with. "I walk five miles a day" is grief disguised as logic. Agree that it makes the news harder to believe, explain that bowel cancer commonly causes no pain and few symptoms until it is found exactly this way, and do not debate him out of his shock. The person in the waiting room is part of this consultation. Offering Carol in — and repeating the news with her present, answering her questions too — is worth clear marks, and spares him the task of re-breaking the news alone in the car park. End with a small, concrete map: what it is, what is unknown, scan, team meeting, who phones him and when. Shocked patients retain three or four facts at most; make sure the four they retain are the right ones.
Guideline references
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.