When preparing for the MRCGP Simulated Consultation Assessment (SCA), it is easy to get caught up in the medical aspect. But let’s take a step back. The heart of every consultation isn’t just the diagnostic component—it’s the person in front of you. It’s about truly being with them, understanding their story, their ideas, concerns, and expectations (ICE).
The real challenge is to go beyond ticking boxes. If we approach ICE mechanically, the consultation risks becoming a rigid interview rather than a meaningful conversation. Instead, we need to tune in to the patient, responding to what they bring in the moment. For the MRCGP SCA, candidates are expected to be flexible, adapting to the situation and allowing the conversation to flow naturally.
In this article, let’s explore how to elicit ICE naturally, creating a space where patients feel genuinely heard and understood—a space where we’re connecting with the person.
Moving Beyond the Checklist
The temptation to turn ICE into a box-ticking exercise is understandable. It feels safe and structured. But when we do that, we risk losing sight of the person before us. We might be so focused on gathering information that we forget to listen. Instead, think of ICE as a compass, gently steering the conversation rather than dictating every turn.
Stay present. Take a breath and attune yourself to the patient’s world. What are they really saying? How do they seem to be feeling? What’s not being said? Trust yourself to pick up on the cues that emerge naturally.
Ideas: Encouraging a Safe Exploration
Directly asking a patient, “What do you think is wrong?” can feel more like an interrogation than an invitation. It can shut down the conversation before it even begins. Instead, let’s create a safe space where they feel comfortable sharing their thoughts, however uncertain or incomplete.
Try reframing your approach:
- “I’m curious to hear what’s been on your mind about all this.”
- “You know your body well—what’s your sense of what might be going on?”
This approach says, “I’m interested in your perspective,” and, “It’s okay not to know.” It’s about making them feel heard and respected as the expert on their own experience.
Concerns: Tuning into the Emotional Landscape
When a patient shares a worry, like the fear of cancer, our instinct might be to rush to reassure or gather facts. But if we jump too quickly into problem-solving mode, we can overlook the depth of their fear. Instead, let’s first acknowledge their feelings, allowing them space to express and explore their emotions.
Shift the focus to their experience:
- Patient: “I’m worried I might have cancer.”
- Doctor: “That sounds frightening. Tell me more about what’s been worrying you.”
This response says, “I see your fear, and I’m here with you.” It’s not about solving the problem right away but about showing empathy and presence. When we do this, we build trust and lay the groundwork for a more collaborative exploration.
Expectations: Setting the Stage for a Shared Journey
Asking, “What are you expecting today?” can sometimes sound dismissive, as if we’re bracing ourselves to say no. Instead, inviting them to share what they’re hoping for helps us align our efforts and manage expectations together.
Create a shared agenda:
- “What would you like to get out of today’s conversation?”
- “What were you hoping from this consultation?”
These phrases open the door to shared decision-making, where we’re not just the experts dictating what will happen but partners navigating the consultation together.
The Dance of the Consultation
Every consultation is a dance between structure and spontaneity, between guiding and following. By letting go of rigid frameworks and focusing on being with the patient, we create space for a more genuine connection. This is where true understanding happens, where we can not only address the patient’s medical needs but also their deeper concerns and hopes.
Successful consultations aren’t about the perfect question or the ideal structure. They’re about how we make the patient feel—heard, understood, and cared for. So, let’s trust ourselves to move beyond the checklist and engage with the person in front of us, moment by moment.
How did this GPST pass MRCGP SCA?
