Communication
What candidates must know
Communication is a clinical skill assessed as a competency, not a soft extra. Understand consultation models (e.g. the Calgary–Cambridge guide: initiating, gathering information, building relationship, explanation and planning, closing), the value of open-to-closed questioning, summarising and signposting. Know how to explore the patient's ideas, concerns and expectations (ICE), how to break bad news (SPIKES), and how to negotiate a management plan with a patient who disagrees. Understand the role of the interpreter, health literacy, and communication with relatives and carers. Recognise that the patient's agenda and the doctor's agenda must both be addressed.
Traps in questions
- Premature reassurance or premature advice is a common error - explore before explaining.
- ICE is frequently the tested concept: questions ask what to explore first when a patient presents with a symptom.
- Jargon and information overload reduce adherence; chunk and check understanding.
- Breaking bad news: warn the patient, use clear language, allow silence, and check understanding - do not rush to reassure.
- The correct answer is often a question, not a statement - open exploration precedes explanation.
Rule of thumb
Ask before you tell. In communication questions, the best next step is usually an open question that elicits the patient's perspective, followed by a summary that confirms shared understanding.
Worked example
A patient with newly diagnosed diabetes says, "I don't want any of those tablets." Rather than persuading, the skilled response is to explore the concern ("What worries you about the tablets?"), acknowledge it, then provide information in chunks and agree a plan - addressing ICE before education.