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How to counsel/explain to patients

How to counsel 

  • Beginning
    • Introduce yourself and explain why you are there
    • Build rapport before launching into the explanation 
    • Ask if the patient knows why they are there. Ask them what has happened up to this point.
    • Assess their prior knowledge – it is important to find out what they already know
    • Tell them what you plan to talk about, ask if they would find that useful, and check there isn’t anything else they want to discuss
  • Middle
    • Consider using diagrams where appropriate
    • ‘Chunk and check’: this is very important – only give small ‘chunks’ of information at a time, then check their understanding. Pause after each section in case the patient has any questions.
    • Speak slowly and clearly. Listen to the patient and be alert to their concerns.
  • Ending
    • Summarise what you have talked about and make a plan
    • Check they’ve understood everything
    • Ideally you should offer something, e.g. a leaflet, website address, specialist nurse contact, follow-up appointment

How to structure explanations

  • Explaining a disease
    • Normal anatomy/physiology
    • What the disease is
    • Cause
    • Problems and complications 
    • Management
  • Explaining a procedure 
    • Explain what it is
    • Reason for it
    • Details of procedure (before, during, after)
    • Risks and benefits

If you are also asked to obtain consent: thoroughly check their understanding, get them to weigh up the pros and cons, and ask them why they chose their answer 

  • Explaining a treatment 
    • Briefly check for contraindications to the treatment (where relevant)
    • Check patient understanding of condition 
    • How treatment works
    • Treatment course and how it’s taken
    • Monitoring required
    • Side effects

Tips

  • Let the patient guide the consultation 
  • Follow cues 
  • Ask what they want to know and about their worries
  • Don’t forget ICE (Ideas, Concerns and Expectations)
  • Empathise
  • Be aware that you may be breaking bad news without realising it! A SPIKES approach can help here (see notes on breaking bad news p337).
  • Avoid all medical jargon
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