Communicator
Communicator
This domain tests the observable interview: whether you can obtain valid information, explain risk and treatment, assess capacity, and document in a way that another clinician could defend.
Core rules
- Structure the interview: open questions first, then focused closed questions; screen for suicide, violence, self-neglect, and safeguarding at every first assessment.
- MSE is communicated in standard headings: appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition, insight, judgement, risk.
- Informed consent requires capacity, adequate information, and voluntariness. Capacity is decision-specific: understand, retain, weigh, and communicate the decision.
- Under the Mental Healthcare Act 2017, admission and treatment have specified consent and review procedures; ECT has additional safeguards. Do not accept a relative's consent for a competent adult.
- Use SPIKES for bad news: Setting, Perception, Invitation, Knowledge, Empathy, Strategy/summary.
- Document facts and quotes, not judgements; record risk discussed, capacity assessed, and who was involved.
Worked example
A 45-year-old woman with schizophrenia refuses admission and says voices tell her to jump from a roof. She can repeat the risks but says the voices are more real than the doctors. Capacity: she understands the information but cannot weigh it because of the illness. This is treatment-related incapacity with serious risk. Explain, involve her nominated representative, and proceed under MHA 2017 provisions; document the capacity reasoning, not just lacks insight.
Traps
- Writing poor insight instead of showing the capacity reasoning.
- Letting a family member consent for a capacitous adult.
- Using jargon and assuming understanding.
- Omitting the risk section or writing no risk without evidence.