Steps What to say What not to say Important point

Examiner Greet him nicely , handshake Don’t look at the SP

Greetings Start with happy face and handshake
except breaking bad and psychiatry
Sit in the chair first
Than look at the stimulator
Start with greetings :
Hallow , I am xyz, I am one the junor
doctor in …….
Are you ……. ?
“what would u like me to call u “( this
line is mentioned as standard in GMC
website )
Nice to meet you zxy
Pause a little bit ( the patient may have
a opening line )
Open question If no opening line, than start with open
question, How can I help u today ?
If the patient has come for report, say
from my note I can see u have done
…… yes I have the report with me right
now , but before moving on to that , will
it be alright if I ask few question
Don’t look at the stimulator before sitting
Don’t start the consultation with ‘how may I address
you?
DON’T SMILE IN BREKING BAD AND
PSYCHIATRY
After the open question Don’t interrupt
when the patient is talking, it is called
golden minute OF HISTORY
Don’t jump in after first line , patient may have 2
or 3 opening lines.
Don’t refer to patient with a title and
their firstname, it would not be
considered normal to address him as
Mr John
Do active listening ( hmmm, ok,
umm, go on , head nodding , use
silence ) there is a score for active
listening.
Be careful about the cues in the
1st minute

‘Please Tell me more about your xyz’

Close question Onset Don’t ask Q out of context . it’s like a ping pong There is mark for picking up cues
Regarding the Duration game. U ask , patient reply, ur next question is Any thing mentioned twice,
symptom Progression based on patients first answer. any sudden change in tone,
Aggravating Factor any expression sad, depressed is
ODPARA Relieving Factor If u miss a cue it will take a lot of time to find the info cue
Associated symptoms again.
Anything Else Vocalize the cues
Don’t say ‘May I ask you some questions?’; ‘Is that OK?’
This time look for cues. They are THEY COME Back in
shortcut . they will save a lot of time management
if u can find them . Save time by
shortening the question , instead of
asking do u have fever ? say any
fever? Say it in a questioning voice.
Rule out Check the red flags Don’t ask question blindly out of nowhere .Sign post if ‘Mr x when it comes to XYZ there
serious Signpost if questions may seem necessary are few things we would like to
problems unrelated to patient ask ‘
Check life threatening d/d first
P3MAFTOSA III. Past complains it will depend on station , avoid asking all the Allergy history is very important,
III. Personal complains questions in all stations . are you allergic to anything
IV. Medication including any medication ?
V. Allergy because ur management will
VI. Family history change if patient is allergic to any
VII. Travel history common medication
VIII. Occupation history
IX. Social history
X. Anything else

ICE questons Ask this question differently
[ You hv had these problems for weeks
now , i was wondering if u hv any
thoughts or worries about what might be
wrong]
1.NEVER EVER ask do u ask any idea /concern / Very important , don’t miss .
expectation ? mark for patient centered
consultation is there
2. if the patient has already said don’t ask again
THEY COME Back in
management

Psychosocial Before entering personal history Don’t say ‘May I ask you a personal question?’ There is a mark for asking this
signpost, now I am going to ask you Use softening phrase . questions
few question regarding ur lifestyle
Tell me , THEY COME Back in
1. Tell me what you are doing in can I just check with you , management
your life at the moment , are u if I may ask
at college , working or what
2. Do you mind if I ask who’s at
home
3. Do you drive ?
4. How is it affecting ur life
5.
Summarize Incorporate c/c , main diagnosing point “ to put this in the context of you…..c/c, concerns it shows u were listening properly
concern, affects on life ,psychosocial “
Examination You have to clearly mention to the Don’t forget to do examination to rule out patient Do a running commentary
patient what examination you want to concern, ex. Doing eye exam for papilloedema in If any picture is given describe it
Investigation do, what will it involve, take permission, headache if patient is worried of cancer.
mention a chaperon will be there

Management has four parts : dealing with the concern , giving the diagnosis , management of issues , safety netting follow up .
you have to address patients worry or concern, than explain why u think of that diagnosis , give explanation for that, check patients understanding of the diagnosis ,
then comes the issues , ask the patient which one u want to know first, a good management plan includes prescription and referring , whatever option u explain give
him pros and cons, check patients understanding of the treatment plans, do the safety netting and follow up .

Start with patient concern , from the Earlier u mentioned that u are concerned about having XYZ , from my assessment it seems less
shallow end (is it serious or not ) to likely to be XYZ , rather your abc type problem , with examination findings like abc and
deep end ( the diagnosis ) investigation results like this , this and that tells me that it is more likely to be abc

First check how much the patient Do you know anything about it ?
knows about it .
Would u like me to explain the condition or you are more interested to know about treatment options
Don’t jump to explaining the diagnosis ?
in details, first ask how much the Explain normal first .
patient wants to know . than the abnormal ,

check the understanding of diagnosis

Now comes the golden minute of management. Mention all the issues u want to discuss (treatment option, lifestyle, concern )
ask the patient which one he wants to discuss first .
When describing management plan , There are few issues that needed to be addressed , which one u want to know first ?
talk about various issues . ( use ice and PSY to make a customize plan )

SHARED MANAGEMENT PLAN : ( always try to give treatment option ) Don’t force option if there is no option like in emergency

It is absolutely important to describe
both good and bad side of a treatment
and than ask the patient to judge .
( explain the how a medication will help,
what are the side effect, ask the patient
to consider
Explain options
 What will it involve
 What will happen if u take the
treatment
 Side effect
( check the understanding of treatment
options )
Does it sound like a reasonable option to you ? do you think u can manage time to visit the
counselor ?
Involve the patient , tell them what you are planning to do, why , what will happen . ask permission from
patient . Make sure patient agree with you
“I was thinking that we should refer you to physio, what do you think , would that be convenient for
you ? how would u feel about that, would u feel comfortable with that ? “
( ask the patient if he has any question )
Always ask ‘how does that sound to you ? what do you think about that ?
Am I making any sense ?
“Can I just ask u to run through what I said so I can see if there are any important bits I missed out “

Follow up Tell ur expectation , what will happen if the drugs work , what to look for Tell him when to come for follow up .
serious cases 2 week referral

TRY TO DO IT ALONG WITH TREATMENT OPTION ,

Safety netting DON’T LEAVE IT UNTILL LAST PART .
In gp clinic tell the patient when to come back immediately
In hospital emergency tell to press the emergency calling button
If teaching station tell them to come to u again for finishing

Ending End with thank you . if u can’t finish in time still thanks and say u will finish Your consultation later .

In emergency station ask for news chart early in history , check oxygen level , stabilize patient and then talk. In management don’t bother with going to specialist
treatment, just stabilize the patient , say our XYZ team will assess and treat you for your XYZ

In teaching station : don’t bother finishing the station, praise the student, . Ask what he wants to know , give info , ask question give feedback. Teach everything
sequentially. tell him u will continue to teach later.

In conflict resolution type case : hear what happened first, go for how he felt, what he thinks should have done , what he wants now and what u are actually going to
do. Don’t defend anything without knowing.

In counseling station / report station : start from the point from which everything started. Why did u go to dr in first place, what happened after that , are you taking
any medication, is it controlled , anything new happened than come to present. Talk less in this station , let the patient talk more. Address his concern that’s most
important. In counseling main issue is to understand patients concern , not telling him everything .

THE EXAM IS NOT ABOUT HOW MUCH U CAN TELL, IT’S ABOUT ADDRESSING THE PATIENT’S CONCERN .