Ideas, Concerns and Expectations (ICE)

A key component of history taking involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE). Asking about a patient’s ideas, concerns and expectations allow you to gain insight into how a patient currently perceives their situation, what they are worried about and what they are expecting from the consultation. It can sometimes be challenging to use the ICE structure in a way that sounds natural in your consultation. As a result, we’ve put together some example phrases for covering each of the three points.

Ideas

Examples of how to explore a patient’s ideas:

• “Tell me about what you think is causing the problem.”
• “Do you have any theories about what might be going on?”
• “It’s clear that you’ve given this a lot of thought and it would be helpful to hear what you think might be going on.”
• “What do you think might be happening?”
• “What’s your best guess as to what is causing this?”
• “Do you have any ideas as to what is going on at the moment?”

Concerns

Examples of how to explore a patient’s concerns:

• “What’s your biggest worry at the moment regarding what this might be?”
• “Are you worried about this being anything in particular?”
• “In your darkest moments, what do you worry about?”
• “What’s the worst thing you were thinking it might be?”
• “What’s your number one concern regarding this problem at the moment?”

Expectations

Examples of how to explore a patient’s expectations:

• “What were you hoping I’d be able to do for you today?”
• “What would ideally need to happen for you to feel today’s consultation was a success?”
• “What do you think might be the best plan of action?”
• “What were you hoping would happen today?”
• “You’ve obviously thought about this quite a bit, did you have any thoughts on the best way we could tackle the issue?”