Table of Contents
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
