Communication and consultation skills
What the exam asks
This domain treats the consultation as a procedure: structure, shared decision-making, and communication with people who are distressed, angry or have additional needs.
Core rules
- Use a recognised structure - Calgary-Cambridge: initiating, gathering information, examination, explanation and planning, closing. Build rapport and signpost each section.
- Elicit ICE (ideas, concerns, expectations) early; it changes what you say next.
- Explain in chunks of a few sentences, then check understanding with teach-back ('Can you tell me what you will do if the pain returns?')
- Shared decision-making after Montgomery means discussing material risks, benefits and reasonable alternatives, including doing nothing - what a reasonable person in that patient's position would want to know.
- SBAR for handover: Situation, Background, Assessment, Recommendation.
- Breaking bad news: SPIKES - setting, perception, invitation, knowledge, emotions, strategy.
- Use professional interpreters, not relatives, and meet the Accessible Information Standard for sensory or learning disability needs.
Worked example
A 45-year-old asks for a PSA test 'to be safe'. Confirm his understanding, explain there is no UK screening programme because of overdiagnosis and uncertain benefit, give absolute numbers for his age, and confirm his choice. Document the discussion; do not simply order the test to end the consultation.
Traps
Interrupting within the first 20 seconds; quoting relative risk ('halves the risk') without absolute figures; agreeing a plan without checking the patient accepts it; missing cues from a relative; treating 'no further questions' as consent.