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).
  • Avoid all medical jargon

Now try it out for real!

  1. Initiating the COCP
  2. Explaining colonoscopy
  3. Post-operative complication
  4. HIV result
  5. Antidepressant counselling
  6. There’s loads more stations here!
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