Lesson 2.1: Opening the Consultation
Your first 30 seconds set the tone for the entire station. A warm, professional, structured opening scores marks before you have asked a single clinical question, and communicates instantly to the examiner that you know what you are doing.
The Standard Face to Face Opening
- Knock gently and enter. Stand tall. Appear calm and confident.
- Greet and introduce: "Good morning / afternoon. I'm Dr [surname], one of the resident doctors here today."
- Confirm patient identity: "Could I check, are you [full name]? And could you confirm your date of birth?"
- Ask for their preferred name: "What would you like me to call you today?" Use exactly the name the patient gives.
- Confirm age separately: "And could you kindly confirm your age for me?" Age is clinically relevant and confirms the briefing details.
- Build rapport (if calm): "Nice to meet you, [name]." If the patient is visibly distressed, say: "I can see this has been difficult. Let me know if I can do anything to make you more comfortable."
- Open question: "What's brought you in today?" or "How can I help you today?"
- Listen without interrupting for 30–60 seconds. The role player delivers key information in their opening statement.
- Signpost: "Thank you, I'd like to ask some more questions to understand what's going on. Is that okay?"
The term "junior doctor" has recently been replaced by "resident doctor" in the UK. Use "resident doctor" when introducing yourself.
Never say 'Hi' too casual. Never ask 'How are you?' they are unwell, which is why they are here. Always introduce yourself and confirm identity before asking anything clinical.
Starting with an open question is extremely important. Never ask a closed question early on. Give the patient space to speak freely before you narrow down with focused questions.
Common Opening Mistakes
| Instead of | Say | Why |
|---|---|---|
| "Hi" | "Hello" / "Good morning" / "Good afternoon" | Too casual for a professional consultation |
| "You must be Mr Smith" | "Could I confirm, are you Mr Smith?" | Incorrect: patients should confirm their own identity |
| "Dr Raha" (first name used with "Dr") | Either "Raha" (first name alone) or "Dr Khan" (Dr with surname) | Using "Dr" together with a first name is a mistake. Professionalism: surname is standard in NHS settings when using the title "Dr" |
| "Nice to meet you" (when patient is distressed) | Acknowledge distress instead: 'I can see this is a difficult time' | Contextually inappropriate, reads as indifferent |
| "I'm going to ask you some questions" | "I'd like to ask some more questions, is that okay?" | Paternalistic, consent is not a formality, it is a habit |
Doctor's Plan vs Patient's Plan — The Opening Line Depends on Who Called the Meeting
Many candidates use 'How can I help you today?' as a universal opener. But when you initiated the meeting, this question implies the patient has come to you with their own agenda, which is not accurate. Adapt your opening line to the situation.
| Situation | Opening Line | Why |
|---|---|---|
| Patient booked or requested the appointment | "How can I help you today?" / "I understand you wanted to speak to one of the doctors, what would you like to discuss?" | Patient initiated, let them lead. |
| Follow-up or review you arranged | "I understand you're here for your follow-up. How have things been since we last spoke?" | You initiated, don't pretend you don't know why they're here. |
| Patient referred by their GP | "I understand you've been referred by your GP. I'd like to go through things with you today." | The referral is the context, acknowledge it. |
| Patient called by the practice (telephone) | "I'm calling about your recent test results / because you contacted us earlier." State the reason clearly. | Never make the patient guess why they've been called. |
| Patient asked to come in by someone else | "I understand someone asked you to come in today. Do you know why they were worried?" | The patient may have no idea, start with their understanding. |
Challenging Openings — Adapting to What the Patient Presents With
PLAB 2 does not reward robotic openers. It rewards situational awareness, how well you adapt your tone, phrasing, and questions to what the patient brings into the room. These scenarios come up regularly.
A. Patient with 'some concerns'
Often written in the stem as 'a patient has come in with some concerns.' Do not repeat the line back to them. Open the space:
- "I understand you've got some concerns, how can I help you today?"
- Use open body language. Face the patient. Offer space to talk without interrupting.
B. Embarrassing or private problem
Common in stations involving sexual health, erectile dysfunction, self-harm, abuse, or genital symptoms. Normalise before they explain:
"I want to reassure you, we see a very wide range of personal and sensitive issues every day, and everything you share with me today will remain completely confidential. You're in a safe space here. What would you like to talk about?"
C. Patient prefers a doctor of a different gender
Common in intimate examination stations or when the presenting concern involves sexual health or past trauma. Accept the preference gracefully:
"That's completely understandable. May I ask if there's a particular reason? I ask only to make sure we can meet your needs. I'm fully trained to handle sensitive situations with care and professionalism, would it be alright if we proceed, and I can arrange for a colleague to continue if you'd prefer?"
D. Patient was asked to come by someone else
Common in dementia, early mental health concerns, or subtle safeguarding cases. The patient may be unaware of the concern or resistant:
- "I understand someone asked you to come in today. Do you know what they were worried about?"
- "And do you feel the same way, or do you think they were being overcautious?"
- If the patient lacks insight (possible dementia): gather collateral history gently and acknowledge their perspective.
E. Patient is angry or upset when you enter
Common opening: 'Finally someone has come' or 'Nobody is helping me.' Do not defend the team. Do not explain before you listen:
"I can see you're really upset, and I'm sorry you've had to wait. I'm here now and I want to understand what's been going on. Can you tell me what happened?"
Confirm identity after the emotion settles: 'Before we go further, could I just confirm your name and age?' Use 'upset' or 'frustrated', not 'angry' (which can feel like an accusation).
F. Patient is withdrawn, hesitant, or afraid
Common in cases involving abuse, self-harm, sensitive social history, or when the patient appears to want help but cannot ask directly. Start normally but stay observant. If they give a vague reason (e.g. 'I just need a sick note'):
- Acknowledge: 'It seems like something might be troubling you. Are you okay?'
- Reassure: 'Take your time, there's absolutely no rush. I'm here to help.'
- Offer confidentiality: "Everything you share with me today will remain completely confidential." Do NOT say "This is just between us", it sounds casual and is not the correct framing.
G. Concerning body language
Do not name the behaviour, name the feeling. Avoid: 'I can see you're not making eye contact' or 'You seem nervous.' Instead:
| What You Observe | What to Say |
|---|---|
| Fidgeting, restlessness | "You seem a little unsettled, is there something on your mind?" |
| Looking down, avoiding eye contact | "It seems like something might be weighing on you. Would you like to talk about it?" |
| Very quiet voice, hesitant answers | "I can see you're not feeling your best. Take your time, I'm listening." |
H. Patient who seems emotionally settled but withdrawn
Some patients present very flat or matter-of-fact even when the situation is serious. Avoid interpreting composure as lack of concern. Ask gently: 'How are you feeling about all of this?' rather than assuming.
Initial Approach Toolbox — Quick Reference
| Situation | What to Say |
|---|---|
| Generic concern | "How can I help you today?" |
| Embarrassing / private issue | "Everything you share will remain confidential. You're in a safe space here." |
| Gender preference | "That's completely understandable. Would it be alright if we begin, and I can arrange a colleague if needed?" |
| Patient referred by GP / sent by someone else | "I understand you've been referred / asked to come in. Do you know the reason?" |
| Patient angry or upset | "I can see you're upset, I'm here now and I want to understand." |
| Patient withdrawn or hesitant | "Take your time. There's no rush, I'm here to listen." |
| Confidentiality needed | "Everything we discuss today will remain completely confidential." |
| Follow-up (doctor's plan) | "I understand you're here for your follow-up today. How have things been?" |
| Patient-initiated visit | "What would you like to discuss today?" |
Telephone Consultations — Structured Opening
In telephone stations, a phone will be present on the desk and the call will already be connected when you enter the room. Do not touch the phone or the monitor, this will disconnect the call. Read the briefing card before picking up.
Work through these steps in order:
| Step | What to Say |
|---|---|
| 1. Confirm person | "Hello, am I speaking to [name]?" |
| 2. Introduce yourself | "I'm Dr [surname], one of the doctors calling from [GP surgery / department]." |
| 3. State purpose | "I'm calling because I understand you phoned us earlier / about your results / for your follow-up." |
| 4. Ask for consent | "Is now a good time to talk?" Do NOT ask this in emergencies. Ask it in all non-urgent calls. |
| 5. Confirm identity | "Before we go ahead, could I confirm your date of birth?" |
| 6. Preferred name | "Is it alright if I call you [name]?" |
| Instead of | Say |
|---|---|
| "This is just between us" | "Everything we discuss will remain completely confidential." |
| "Hi" | "Hello", always formal on a professional call |
| Start speaking before reading the briefing | Always read the full briefing card before lifting the phone |
| Skip ID check in a staff call | Always confirm who you are speaking with |
Because you cannot see the patient in a telephone station: ask explicitly about visible signs ('Are you breathing comfortably? Any visible rash or swelling?'); check understanding more frequently; be extra specific with safety netting.
Speaking to a Relative or Carer
- Greet and introduce yourself.
- Confirm their name and relationship: "Could I ask your name and your relationship to the patient?"
- Confirm patient name and age: "And could I confirm the patient's full name and age?"
- Open: "Thank you, can you tell me what's been going on?"
- Before sharing any clinical information: check the patient has given consent, or that they lack capacity. A relative cannot consent on behalf of an adult, they can only inform the best-interests decision.
Signposting — Guiding the Patient Through the Consultation
Signposting is the act of clearly introducing what you are about to do or ask next. It improves patient comfort, builds rapport, and signals to the examiner that you are in control of the consultation structure.
Standard transitions:
- "To help me understand better, I'd like to ask you a few more detailed questions now."
- "Now that I understand the main concern, I'd like to check for anything serious that we shouldn't miss."
- "I'll now ask about your general health background."
- "Before we finish, I'd like to ask a couple of quick questions about your lifestyle."
Signposting in challenging situations:
- Redirecting an angry patient: "I can see this is really frustrating. Before we go further, I just want to make sure I understand everything properly, would that be okay?"
- When time is running short: "I want to make sure we cover the most important points. Let me quickly summarise what we've discussed and then I'll explain the plan."
- When the patient becomes emotional: "I can see this is difficult. Take your time, there's no rush. When you're ready, I'd like to understand more about what's been worrying you most."