SCA Tips: How to pick up patient cues in your MRCGP SCA exam consultations

Here are several strategies you can employ to effectively pick up and explore patient cues, ensuring a holistic and empathetic approach to patient care:

Active Listening

Listen to the patient. Don’t be distracted by thinking of the following question to ask. Try not to interrupt too soon. Pay attention to tone, pace, and body language.

• Example: If a patient pauses when talking about a specific issue or their tone shifts, ask, “It seems like that situation was particularly difficult for you. Could you tell me more about it?”

 

Observing Non-verbal Communication

Watch for body language such as posture, eye contact, facial expressions, and hand movements. Non-verbal cues can reveal emotions or discomfort the patient may not express verbally.

• Example: If a patient looks away or seems tense when discussing specific topics, gently explore further by saying, “I noticed you seemed a bit uncomfortable when you mentioned that. Is there something specific about it that’s been on your mind?”

 

Ask Open-Ended Questions

Use questions that require more than a yes/no answer to encourage the patient to share more details about their experience.

• Example: Instead of asking, “Are you feeling stressed?” ask, “How have you been feeling lately, especially with everything going on in your life?”

 

Echoing and Reflecting

Repeat key phrases or ideas the patient mentioned to show you’ve understood. This strategy allows the patient to feel listened to and will encourage them to share more intimate details.

• Example: If a patient says, “I just feel overwhelmed,” respond with, “It sounds like things have been really difficult for you lately. What’s been the hardest part?”

 

Moments of Silence: Allow moments of silence after asking questions, especially sensitive ones, to give the patients time to think and respond.

 

One cue/answer leads to the other.

Use the cue or answer the patient gives you to springboard to the next relevant question. This allows you to showcase structured data gathering, which is a requirement in the SCA

• Example: “You mentioned not sleeping well recently. Have you noticed any other changes, like your appetite or energy levels?”

 

Contradictions/Inconsistency is an Invitation to ask questions

Pay attention to inconsistencies between the patient’s words and their body language or emotional tone.

• Example: If a patient says they’re “fine” but appears distressed, gently explore by saying, “I appreciate you saying you are fine, but I notice you seem a bit tense. Is there something else that’s been on your mind?”

Summary

• Observe your patients for both verbal and non-verbal cues
• If you have a patient who expresses a cue that is relevant, don’t ignore it

Example

James, the patient, is glancing down with a sad demeanour during the opening of the GP Consultation.

Doctor: James, you appear upset about something. Would you mind sharing it with me? I want to help.

Patient: Doctor, I’ve been feeling really down since my grandma passed away last month.

 

Doctor: I’m really sorry to hear that, James. I can see how much this has affected you. Were you close?

• Pause for a moment to acknowledge the patient’s feelings
• Say this in an empathetic tone and maintain eye contact
• Mirroring facial expression to show concern and leaning forward to demonstrate you are paying attention

Patient: Yes, very. She practically raised me when I was younger.

 

Doctor: It sounds like she played a big role in your life. Losing someone so important must be incredibly hard. How have you been coping since she passed away?

• Re-stating what the patient said in your own words affirms you are listening
• Directing the conversation to ask about how he is coping allows you to explore his health, check maladaptive coping strategies and explore his mental health

Patient: Not very well, to be honest. I’ve been struggling to sleep and can’t focus on work.

Doctor: That sounds really tough, James. It’s common for grief to affect sleep and concentration. Sometimes, when people are grieving, and they are excessively sad, it can also cause them to have dark thoughts of self-harming or wanting to end things. Have you experienced anything like that, James?

 

Dr Sakaria Farah
PassCME SCA Tutor