A woman with an infected foot who wants to go home
PLAB 2 practice station

The task

You are a doctor in an emergency department. Mrs Eleanor Whitcombe, aged 74, has type 2 diabetes. She has a spreading red, hot infection of her left foot with a discharging ulcer. The senior doctor has advised admission for intravenous antibiotics and possible surgery. She has said she wants to go home. She is alone. Discuss her decision with her, assess her capacity and agree a safe plan. You do not need to examine her. The examiner will not take part in the conversation.

What this station tests

• Presume capacity; assess it for the specific decision using understand, retain, weigh and communicate.
• An unwise decision by a patient with capacity must be respected.
• Explore her reasons and offer the safest alternative she will accept.
• Document capacity, risks explained and safety-netting; keep the door open.

Sources for the clinical content

• Mental Capacity Act 2005
• NICE NG108: Decision-making and mental capacity
• GMC: Decision making and consent
• NICE NG19: Diabetic foot problems: prevention and management

An original practice scenario with invented patients. Not an exam question.

Practise next

• Follow-up after an emergency hospital visit
• Young teenager seeing the GP alone
• Concern about a struggling colleague
• Itching during an intravenous antibiotic