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







  • GP registrars can get quite confused as to what ideas, concerns and expectations actually means
    • Ideas refers to the patient’s health beliefs – What they think is causing their symptoms
    • Concerns are the worries the patient has about their symptoms and often the reason they have come to see the doctor
    • Expectations are what the patient hopes for or wants to happen next i.e. ‘I want an x-ray’
  • Attempt to explore all of the 3 of the Ideas, concerns and expectations 
    • However, if the patient has already told you their concerns or expectations asking this again formulaically may come across as not listening
    • You can explore other concerns or expectations tactfully by signposting that you have listened to them: ‘You mentioned that you were worried that your pains were caused by bowel cancer, but was there anything else you were worried about?’ 

  • Asking the patient’s ICE in this order may be acceptable 
    • However, be willing to be flexible otherwise you will appear as too rigid
    • Allow the patient to guide you and ensure it is natural. If a patient starts with discussing their concerns explore this before going back to ask about their ideas and then expectations
    • Do not ask for the patient’s ideas, concerns, and expectations too quickly otherwise you will literally ICE them: ‘I don’t know what is going on - you are the doctor you should know!’
  • If the patient mentions a relative or friend who advised them to see you then ask that their ideas and concerns are as well as the patient’s
    • You can say for example: ‘Have you spoken to your wife about it? What did they think? What were they worried about? Do you have the same fears?’
    • Some doctors routinely ask about the patient’s ideas and concerns as well as their partners thoughts even though the patient has not mentioned them in conversation. Whilst it can create conversation this can waste valuable time
  • Asking ICE very well will make it easier to structure your management plan as you will be able to appreciate the patient’s perspective address them personalising your advice 


IDEAS

Have you had any thoughts or theories about what may be going on?
You mentioned you have had it for X days, what did you think was causing it?
What does this all mean to you? / What do you make of all this?
Have thought it may be …?
Have you any ideas about it yourself?
What did your wife/partner think it may be?

CONCERNS

Is there anything that you are worried about that this may be?
What concerned you the most about it? / Do you have any anxieties about it?
Are you worried about anything in particular?
Did you ever worry it may be….?
Is there anything else that may be worrying you?