Introduction, Open questions and focus questions

The MRCGP course organisers have written some quick reference tools to help you pass your MRCGP CSA exam and aid you in your consultation skills. We recommend using and adapting them into your daily consultations to improve your communication skills. All the articles and headings below are covered on the MRCGP course in detail and role-played in the group




  • Stand up and approach the patient as they enter the room
    • Do not remain sitting in your chairs in the CSA exam. Stand up and meet the patient half way offering a smile and gentle handshake if appropriate and gesturing them to their chair
  • Start every consultation with a simple easily rememberable introductory statement
    • Doctors unwittingly sometimes forget to introduce themselves to the patient
    • Do not greet the patient by their first name only as Mr, Miss or Mrs Surname. Ask permission if you want to call them by their first name. ‘Do you mind if I call you Jack. Is that alright?’

  • Use open questions to permit the patient to express themselves freely
    • It may be necessary to ask one, two or rarely even three open questions to start the consultation going
    • Open questions often shorten consultation times as patient tell you much of the history and prevents unnecessary long listed closed question consultations
  • Show active listening in the ‘Golden Minute’
    • Allow the patient to speak without interruption for as long as possible only interjecting with facilitatory comments: ‘yes,’ ‘I see,’ ‘go on,’ ‘umm (nodding),’ ‘ok
    • Adopt an open body language with a friendly welcoming facial expression. Consider altering this to a concerned frown when the patient reveals some sensitive history or symptoms
  • Ask a selection of focused questions to obtain further clarity to the history
    • Use only a few closed questions. These may include red flag symptoms to rule out serious causes. Having too many close questions will make the consultation appear rigid and unnatural ‘Do you have chest pain? – yes. Is it worse in the morning? – no. Is it worse at night?  - yes. Do you get pain when you breath in? – no.’
    • Closed questions include asking the patients drug history, past medical history, and family history
    • Asking the patient’s past medical or family history can be asked to appear open instead of always asking exclusive lists: ‘Do you suffer from any medical problems?’ ‘Does anyone in your family suffer from medical problems?



INTRODUCING YOURSELF

Hello my name is Dr … How can I help you today?
How would you like me to help you today?

OPEN QUESTIONS

Can you tell me more about that?
Tell me how did it all begin?
Exactly how did it start? 
How did it come on?
You mentioned about it earlier, tell me more?
What were you doing at the time?



By Nazmul Akunjee & Muhammed Akunjee
02.4.2014