Qualified doctors, regardless of speciality or context, frequently have to giveinformation 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
Providing lifestyle advice to help a patient lose weight
Although you are rarely expected to give information to patients as a medical student, it is imperative that you learn effective clinical communication techniques to handle these situations.
Effective information giving allows patients to make informeddecisions and participate fully in their care. It also strengths the doctor-patient relationship and can help reduce patient anxiety. This guide provides a brief overview of the key elements of effective information giving.
As with every clinical communication scenario, each situation must be handled individually depending on the clinicalcontext and the patient’s needs.
Ensure you have a goodunderstanding of the subject/procedure before you start giving information – this is imperative to prevent you from providing unclear information and being poorly equipped to answer the patient’s questions.
Look at the patient’s previousconsultations (if relevant) – have they 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? If so, consider how to break the bad news.
Introduceyourself including your full name and role.
Check you have the correctpatient and confirm they are happy to be called by their name (e.g. Joanna or Mrs Smith).
Explain the 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 and explain that you are stepping in for whatever reason.
Gainconsent to discuss the topic with the patient and explain that the discussion will be confidential.
Try to buildrapport from the beginning of the consultation (e.g. offer a chair, ask them how they are today etc).
Check the patient’s agenda
Before launching into delivering the information to the patient (i.e. part of your agenda), check to see what the patient’sexpectations of the consultation are, as they might be different to your own. 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?
“Is it ok for me to speak to you about the investigations you’ve had?”
Were they expecting to receive information today?
‘What were you expecting from today’s consultation?’
Were they planning to discuss somethingelse?
‘Was there anything else aside from the results you were hoping to discuss today?’
Assessment of the patient’s agenda allows you to integrate ‘Ideas, Concerns and Expectations (ICE)’ into your consultation, which often sounds artificial and out of context if asked at the end.
Check the patient’s prior knowledge
Check to see what the patient’s understanding of the subject already is.
It is important you ‘pitch’ the information at an appropriatelevel, 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 patient in front of you, depending on what they already know.
‘In your consultation last week, were the results of your recent investigations explained?’
‘Tell me what you understand about your condition’
By asking questions like the examples above, you may be able to omit information that has already been discussed and understood, allowing more time for exploring the things the patient hasn’t been told or didn’t understand.
Allow the patient to say everything they want to say and avoid interrupting them. When there is a natural pause, you can start speaking again.
If your patient has confirmed that they want to receive the information today, you might need to gather some more information first to assess what they already know.
‘Before I go into the actual steps of the procedure, I’d like to check what you know already, if that’s ok?’
If the patient is explaining what they already know, listen carefully and watch their facial and bodylanguage. Respond to what you see after the patient has finished speaking. This might reveal that the patient’s understanding is incorrect or it may reveal strong emotions associated with the subject matter (e.g. anxiety, sadness).
Once you have checked the patient’s agenda and priorknowledge, 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 the procedure afterwards’
Chunk and check
When giving information it’s important to break it down into sizeablechunks. In addition, make it clear to the patient that they are welcome to interrupt you if they feel you are going too fast or if they don’t understand something.
Watch the patient’s face whilst giving information – look for non-verbal cues that they are feeling overwhelmed by the information you are communicating.
Check the patient’s understanding, by using phrases like “Do you understand everything I’ve said so far?”. This provides an opportunity for the patient to let you know they aren’t clear on something (as they may have been nervous to interrupt and admit this themselves).
A useful method of assessing a patient’s understanding is to ask them to repeat the information you have just communicated back to you in their own words. Try to check understanding at regularintervals, rather than at the end of the consultation.
It can be challenging to check understanding without sounding patronizing, particularly when you haven’t had much practise. The key is to acknowledge that the information is complex and that it is normal to not remember or understand it all initially. A possible example phrase could be:
“I know this is all quite complex, so I just wanted to check I’m explaining it well. Would you be able to repeat back the key points of what I’ve said so far, to make sure I’ve not missed anything?”
Invite dialogue and link the information
Encourage the patient to askquestions during the explanation. Some patients may require this encouragement to feel they have ‘permission’ to interrupt with questions.
Try to link the information you are communicating to what has already been mentioned by the patient:
“You mentioned earlier that the problem is with the stomach lining, which is why the procedure needs to take a sample from it.”
Make sure you explain the information using non-technical language. Some patients may know a lot about their condition and in these cases, you may be able to use some technical terms, but only if they have already demonstrated clear understanding.
Thank the patient and offer additional help
Thank the patient for their time.
Offer the patient supporting written materials or websitelinks to read more about the topic.
Acknowledge that you have given a lot of information in one go and that if they have any questions after they’ve left, they are welcome to get in touch to have those questions addressed.