Qualified doctors, regardless of speciality or context, frequently have to give information to patients during consultations. It may form part of the consultation or be the sole reason why the consultation was arranged. Some examples include:
- Explaining a surgical procedure before gaining consent
- Explaining how to use an inhaler
- Explaining a new diagnosis and treatment plan
- Lifestyle advice to help the patient lose weight
Although you are not expected to give information to patients as a medical student during training, it is imperative that you know the clinical communication techniques to handle these situations as effectively as possible so to be well prepared for working life.
Effective information giving enables patients to be well informed and have a clear understanding when making decisions/following treatment plans. It can strengthen rapport between the doctor and patient and reduce patient anxiety. The following sections discuss the key principles for effective information giving.
As with every clinical communication scenario, each situation must be handled individually depending on the clinical context, background and patient.
Ensure you have a good understanding of the subject/procedure before you start giving information – this is imperative or you might give unclear information or be unable to answer the patient’s questions.
Look at the patient’s previous consultations (if relevant) – have they been perhaps been given information on this before? Have they been told the diagnosis? Were they given reading material in the previous consultation that they might have questions they want to ask about?
Consider the approach – are you giving the patient information that might be difficult for them to receive? (might it be useful to consider principles related to breaking bad news in conjunction?)
As with every clinical communication consultation, begin your consultation with a good introduction:
- Check you have the correct confirm they are happy to be called by their name e.g. Joanna or Mrs Smith
- Introduce your full name and role and purpose of the interview (e.g. ‘I have been asked to speak to you about some recent investigations you have had’)
- If you are seeing the patient instead of their usual doctor – apologise for the change/explain that you are stepping in for whatever reason. They may be expecting to have the conversation with someone else.
- Gain consent – check they are happy to discuss the topic with you
- Mention confidentiality if relevant
- Build rapport from the start – e.g. offer a chair, ask them how they are today etc.
Check the patient’s agenda
Before launching into giving the information you want to give the patient (i.e. part of your agenda), check to see what the patient’s expectations of the consultation are – they might be different to yours. You might already know the answers to the question from previous notes or the briefing you are given, but it is wise to double check.
- Are they ready/willing to receive information today?
- Were they expecting to receive information today?
- Were they planning to discuss something else?
‘What were you expecting from today’s consultation?’
‘Was there anything else aside from the results you were hoping to discuss today?’
(This is also a way of integrating ‘Ideas, Concerns and Expectations (ICE)’ into your consultation, which often sounds artificial and out of context if asked at the end, unless it directly relates to the context of what is being discussed)
Check the patient’s prior knowledge
Check to see what the patient’s understanding of the subject is already.
It is important you ‘pitch’ the information you are giving accurately, otherwise you might be wasting time telling the patient what they already know and not addressing specific concerns or questions.
Structure and adapt your questions to the specific context. This will vary depending on the scenario.
- ‘In your consultation last week, were the results of your recent investigations explained?’
- ‘Tell me what you understand about your condition’
This way, you can miss out parts of the information that your patient already knows, and spend time exploring more detailed aspects or anything they don’t understand.
Allow the patient to speak completely and start speaking again when there is a natural pause.
If your patient has explained that they want to receive the information today, you might need to explain why you need to gather information first. You could phrase this like this. This is called signposting.
- ‘Before I go into the actual steps of procedure, I’d like to check what you know already, if that’s ok?’
When your patient explaining what they already know listen carefully and watch their facial and body language. Respond to what you see after the patient has finished speaking.
- The patient might show that they are confused/unclear about the information they already know
- They may demonstrate emotion related to subject matter – anxiety, or sadness for example
Once you have checked the patient’s agenda and prior knowledge, it’s appropriate to commence information giving.
Signpost, if not done already, about what information you would like to give the patient:
- ‘Today I would like to talk you through how to use an inhaler’
You could also explain the steps you are going to take:
- ‘First I will talk through the steps and I’ll demonstrate afterwards’
Chunk and Check
When giving information it’s important you break down the information into sizeable chunks. In addition, ask your patient to tell you if you are going to fast for them. Allow processing time.
Watch the patient’s face whilst giving information – look for possibly non-verbal cues that they are feeling overloaded by information.
Check understanding, but using phrases like ‘Are you with me?’ often result in patients saying yes even if they aren’t clear. A good way to check understanding is to ask the patient to repeat the information back to you.
Try to check understanding at intervals, rather than at the end as it may be too much for the patient to repeat back.
The difficulty comes when with trying not to make this sound patronizing. One method is by recognizing that the elements of the subject area may be complex and that often IQ has nothing to do with understanding/retaining new information. A possible example phrase could be: ‘Just to make sure I explained it correctly, could you repeat back to me what your understanding of x is?’
Invite dialogue and link the information
- Encourage the patient to ask comment or ask questions during the explanation – this can help to ensure the patient is understanding.
- Try to link the information to what has been mentioned already by the patient.
- This might include mentioning what the receiver already knows/understands or the context behind why they need to be given the information
- E.g.‘You mentioned earlier that the problem is with the stomach lining, which is why the procedure needs to take a sample from it.’
- Ensure you explain the information using non-technical language.
- Watch the patient’s face when giving information – they may demonstrate non-verbal cues that they aren’t understanding the information correctly
- Be aware that you can base the level of technicality on what the patient volunteers initially, using slightly more complex words to explain the procedure if better outlined this way.
Thank the patient and offer additional help
- Thank the patient
- Offer to help give the information using a variety of formats
- Acknowledge the amount of information you gave might be a large amount
- Offer the patient leaflets/websites so they can read more about the information
General clinical communication tips
As with all consultations, ensure you are utilizing clinical communication skills to enhance the quality of your interaction.
These might include the following
- Demonstrating Empathy
- Building Rapport
- Demonstrating active listening skills