Communication and the patient-doctor relationship
Communication and the patient-doctor relationship
This domain tests how you choose the next thing to say. Items give a short consulting-room vignette and ask for the most appropriate response; distractors are usually plausible but premature.
Core frameworks
- Patient-centred sequence: explore the illness experience - ideas, concerns, expectations, feelings, function - before explaining.
- Useful openers: “What do you think is causing this?”, “What worries you most?”, “What were you hoping I could do today?”
- Motivational interviewing: open questions, affirmations, reflections, summaries (OARS); resist the righting reflex; roll with resistance; elicit change talk.
- SPIKES for bad news: Setting, Perception, Invitation, Knowledge, Emotions/empathy, Strategy and summary.
- Health literacy: use teach-back (“Can you tell me how you will take these tablets?”); use a professional interpreter, not a child or relative, for consent conversations.
Worked example
A 54-year-old with HbA1c 9.2% says flatly, “I'm not going on insulin, doctor.” Options include explaining the benefits, referring to a diabetes educator, asking about his concerns, and warning about complications.
Best answer: ask what concerns him about insulin. Reasoning: he has stated a position, not a settled decision; exploring the barrier preserves the alliance and uncovers the real issue - needle fear, shift work, cost. Explaining first triggers resistance and breaches the righting reflex. The educator referral may follow, but is not the next step.
Traps that cost marks
- Choosing reassurance or patient education as the first move in an emotive vignette.
- Endorsing “ask the family to interpret” or “give a written leaflet” when comprehension is the actual problem.
- Missing that anger in the consulting room usually signals an unmet expectation.
- Confusing empathy (“That sounds frightening”) with sympathy or false reassurance (“Don't worry, it'll be fine”).