Explaining a Diagnosis to the Patient


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






  • Ensure you have the clinical knowledge before attempting to explain it
    • Whilst patient do respect that doctors do not know everything, they do expect them to know and be able to explain common medical problems
    • Having past your AKT exams your medical knowledge will be at an optimum level to tackle the CSA exams
  • When explaining create an environment that permits two way dialog and is bi-directional
    • What you intend to explain will have been built upon what the doctor and patient have already discussed 
    • Permit the patient to interject if necessary when explaining so that it is an interactive process
  • Signpost to the patient that you wish to offer an explanation of their symptoms
    • This can save valuable time in your CSA exam as well as own consultations especially if the patient already knows about their condition and does not wish you to repeat the explanation
  • Check the patient’s current level of understanding about their condition
    • This permits you to check what they already know and see if their understanding needs correcting
  • Ensure your explanation has clarity
    • Attempt to offer clear & unambiguous explanations. Keep sentences short and simple wherever possible
    • Consider using easily rememberable analogies  that the patient can relate to
    • Do home work, using the internet or patient leaflets to look at ways to explain in simple terms common medical problems i.e. diabetes, hypertension, stroke, hypercholesterolaemia. Test these explanations on your everyday patients in your clinics before using them in your exams
    • Practising saying theses explanation will make your explanations appear natural and less stuttered
  • Avoid medical jargon where possible
    • Use simple vocabulary that is likely to be understood by the recipient. Spend time of thinking of ways to explain conditions without the use of medical terminologies or jargon.
    • The patient’s trust in their doctor may be shaken if their doctor appears to lack confidence in what they are saying or if they are left confused but what they are hearing
    • Tailor your explanation to your patient. Avoid offering over simplistic explanations to an educated patient as this can be received as being condescending. The opposite also applies
    • Patient leaflets or www.patient.co.uk are a good resource for explanations that lack medical jargon
  • Pace the amount of information when giving your explanation
    • Appropriate pauses are useful to break your explanation in to retainable and digestible chunks .
    • Patients will feel they have an opportunity to interrupt if they are unclear about things
  • Weave some of the information offered by the patient in your own explanation 
    • Incorporate as well as acknowledge the patient’s own understandings when giving your explanation, ‘You are right when you thought that spicy foods can make indigestion worse’
    • Weave this information into your explanation even if it is incorrect. This demonstrates that you are listening. ‘I know you said that you were worried that your chest pain was caused by a heart attack as you had watched it on TV, but I can reassure you that is more likely to be caused by a muscle strain. This is because…’
    • Try to quote the same vocabulary the patient has used in their history where possible in your explanation
  • Use diagrams or offer leaflets if appropriate
    • Occasionally using diagrams or drawings are useful way to explain things 
    • Consider offering practice leaflets to patients. However, do summarise to patient its content rather than just giving one for the sake of it 

SIGNPOSTING 

Do you want me to explain what diabetes is? 
From what you have said to me and after examining you I think you have cellulitis. Do you want me to go through this with you? 


CHECK LEVEL OF UNDERSTANDING
Tell me what do you already know about COPD?
Have you read or heard anything about it before?
What does diabetes mean to you? 


WEAVE THE PATIENT’S OWN WORDS IN YOUR EXPLANATION

The ‘room spinning around’ that you described is because you have… 
I am a little worried when you said it feels like a ‘hammer hitting your head’. I think it could be …
How has it affected your home life? How are things at home?
Has your symptoms affected your relationship?


CHECK UNDERSTANDING
I am really sorry but I am worried that I have confused you. Is there anything you want me to go through again?
Is there anything I have said that I could have made more clear?
I am sensing that you are still worried about something? Am I right?


By Nazmul Akunjee & Muhammed Akunjee
04.04.2014