1-INITIATE PROPERLY

Hello I’m Dr Perera

Is it Margaret French?
I’m one of the dermatologists attached to the hospital.
Your family doctor has asked me to see you about the joint problems you’ve been having.

2- BE ATTENTIVE & RESPECTFUL!

What I would like to do now is spend a few minutes with you discussing your symptoms.
Is that alright?
Please let me know if you are feeling uncomfortable at any time!!

3-NON JUDGEMENTAL

So, what worries you the most is that the abdominal pain must be caused by cancer.
I can understand that you would want to get it checked out.

4- EMPATHY

You mentioned earlier that you were concerned that you had angina.
Angina is a very particular kind of pain which relates to several underlying conditions.
Is it ok if I ask you a few more questions to rule out muscular pain?

I can see that your husband’s memory loss has been very difficult for you to cope with.
I imagine I would feel similarly if the same thing happened to me.

5-ELICIT & EXPLORE PATIENTS CONCERNS

Do you have any thoughts about what might be causing your symptoms?

Was there anything particular that you were concerned about?

You mentioned that you were concerned about the effect the illness might have on your work.
Could you tell me more about it?

6- PICK PATIENT CUES & REACT ACCORDINGLY

You used the word worried!! Could you please tell me more about what you’re worried
about?

I sense that you’re not happy about the explanations you’ve been given in the past.

7- RELATE YOUR EXPLANATIONS TO WHAT PATIENT HAS SAID.

As you say you’re having trouble sleeping at the moment, let’s talk about things that might
help you address this before we move on.
8- TELL PATIENT YOUR NEXT STEP

You mentioned two areas that are obviously important.

First, the joint problems and the tiredness and second, how you’re going to cope with your
children.
Could I start by just asking a few more questions about the joint pains and then we can come
back to your difficulties with the children.

9- ORGANISE YOUR EXPLANATIONS.

There are three important things I want to explain.

Firstly, I want to tell you what I think is wrong.
Secondly, what tests we should do.
And thirdly, what treatment options are available/what the treatment may be.

10- HIGHLIGHT SIGNIFICANT INFORMATION.

It is particularly important that you remember this!!

11- CHUNKS OF INFORMATION.

12- SUMMARISE.

So just to recap: we have decided to treat this as a fungal infection with a cream that you
apply (put on) twice a day for two weeks and if it is not better by then, you’re going to come
back to see me.

Can I just see if I’ve got this right?

You’ve had indigestion before, but you have taken painkillers.
This has been accompanied by bloating and it’s stopping you from sleeping.
It’s made worse by drink and you’re wondering if the pain killers were to blame.
Is that right?

OTHER

a) Encouraging patient
Um... uh huh... I see!

b) Repeat/echo patient’s complaints

Chest pain? Not coping?

c) Rephrase
Are you thinking that when John gets even more ill you won’t be able to nurse him at
home by yourself?

d) Open Q in the beginning

Start at the beginning and take me through what has been happening.

How have you been feeling since your operation?

Tell me about your headaches.

e) Directing Q in the middle

What makes your headaches better or worse?

f) Closed Q later
Do you ever wake up with this headache in the morning?

g) Avoid compound & leading Qs

h) Clarify information
Could you explain what you mean by “light-headed”?

When you say “dizzy”, do you mean that the room seems to actually spin around?

GIVING INFORMATION TO PATIENT

What patient already knows

It would be helpful for me to understand a little of what you already know about
diabetes, so that I can try to fill in any gaps for you.

Based on your blood test results your cholesterol level is high. So we need to
discuss about ways to reduce it. What do you know about LIPITOR

Take breaks while explaining

Periodic pauses

Encourage patient to contribute reactions

What questions does that leave you with?
Do you have any concerns about what I have said?

Check patient’s understanding

I know I’ve given you a lot of information today.
And I’m concerned if I might not have made it very clear.
Could you repeat them back to me what we have discussed so far so I can make
sure we are on the same track?

What further information patient needs

Are there any other questions you would like me to answer or any points I haven’t
covered?