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!