Explaining a new diagnosis — type 2 diabetes
PLAB 2 & PRES 3 · endocrine · medium · 8 minutes
Candidate brief
You are an FY2 doctor in a GP surgery. Mr George Adeyemi, 58, had routine blood tests after a well-man review. His HbA1c came back at 54 mmol/mol, and a repeat test has confirmed 53 mmol/mol. His blood pressure is 138/84 mmHg and his BMI is 31. The diagnosis of type 2 diabetes has not yet been discussed with him. Please explain the diagnosis, what it means for his health, and the management plan. Address his concerns.
What examiners look for
Explanation stations are won in the first minute: find out what the patient already knows, expects and fears BEFORE you explain. This man cannot hear a word about metformin until someone has dealt with the picture of his father's leg. Deliver the diagnosis plainly, then stop talking. A diagnosis delivered and immediately buried under information scores worse than a shorter explanation with pauses where the patient reacts and asks. Translate every number. "HbA1c 53" means nothing to a patient; "a test that shows your average blood sugar over the last three months — and yours is above the line where we call it diabetes" means everything. If you would not say it to a relative, do not say it here. The asymptomatic paradox needs naming: he feels fine AND he has diabetes. Explain that early type 2 diabetes is silent, that the test found it early, and that early is exactly when treatment changes the ending. Complications must be framed as the reason for treatment, never as a threat. "This is what we are going to work together to prevent" motivates; "this is what will happen to you" only frightens — and in this station it re-opens his father's story. Be accurate about insulin and about remission. Tablets first for most people; insulin is not a punishment and not today's plan. Remission through weight loss is real for some people with early type 2 diabetes — offer it as hope with evidence behind it, not as a promise or a bargain. Practical life questions (licences, insurance, work) are clinical questions in disguise. Answer what you know, flag what he must check with his licensing authority, and never bluff a rule that affects a man's livelihood. Close the loop at home: "What will you tell your wife tonight?" reveals in ten seconds whether your explanation landed — and offering written information and a follow-up with her present turns one consultation into a plan.
Guideline references
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