Explaining is a two-way activity
Many candidates treat information giving as a speech: they deliver everything they know about the condition, then ask "Any questions?". On a recording, that sounds like one long voice with no space for the patient. Good information giving is a conversation in small steps. A B grade usually needs around 2 out of 3 here (approximate). In our words, there are five behaviours:
| Indicator | What the listener hears |
|---|---|
| E1 Finding out what the patient already knows | Before explaining, you ask: "What do you know about...?" or "What have you been told so far?" |
| E2 Pausing and chunking | Information comes in short pieces with natural pauses. What you say next depends on how the patient responds. |
| E3 Encouraging the patient's reactions | You invite feelings and questions during the explanation: "How does that sound to you?" |
| E4 Checking understanding | You check in a way that shows real understanding, often by asking the patient to explain it back. |
| E5 Finding out what else they want to know | You ask whether there is anything else they would like information about. |
E1: start from what they know
Asking first saves time and shows respect. The patient may already know a lot, or may hold a wrong belief you need to correct. Either way, you now know where to begin.
Nurse. A father wants antibiotics for his baby with bronchiolitis.
Bronchiolitis is a viral infection of the small airways. Antibiotics only work on bacteria, so they won't help.
Has anyone explained to you what bronchiolitis is? ... Okay, so you know it's a chest infection. Can I add a little to that, because it explains why antibiotics aren't being given?
Why: The better version checks his current knowledge and asks permission before adding to it. The facts in the weak version are fine, but they land on someone who hasn't been asked.
E2 and E3: chunk, pause, invite a reaction
Give one idea, in one or two sentences. Then pause. The pause is not empty time; it lets the patient react. Then respond to what they say before giving the next chunk. Use plain words. If you must use a medical term, explain it straight away.
| Medical term | Plain version for a patient |
|---|---|
| Hypertension | High blood pressure |
| Myocardial infarction | Heart attack |
| Oedema | Swelling caused by fluid |
| Benign | Not cancer |
| Anticoagulant | A blood thinner, a medicine that stops clots forming |
| Analgesia | Pain relief |
| Bilateral | On both sides |
Doctor. Explaining a new diagnosis of high blood pressure.
Your blood pressure is high, which increases your risk of stroke and heart attack, so we'll start you on a tablet, and you should cut down on salt and alcohol and exercise more and we'll check it again in a month.
Your blood pressure readings have been higher than we'd like. [pause] How do you feel hearing that? ... [response] That's a fair question. Over time, high blood pressure can put extra strain on the heart and blood vessels, which is why we take it seriously. [pause] Shall I talk about what we can do about it?
Why: Each chunk is followed by space for a reaction, and the next chunk responds to it. The weak version is correct but overwhelming.
E4: check understanding properly
"Do you understand?" is a weak check. Most people say yes even when they don't, and it can sound like a test. A stronger approach is teach-back: you ask the patient to explain the key point in their own words, and you take responsibility for the explanation, not them.
Nurse. After explaining how to check blood sugar before insulin.
Do you understand?
I've given you quite a lot of information, so just to make sure I've explained it clearly, could you tell me how you'll check your sugar before your evening dose?
Why: The better version puts the responsibility on the explainer and asks for a specific action. The answer tells you exactly what to repeat.
Phrase bank and E5
Phrase bank: information giving
What do you already know about this condition?
E1, before any explanation.What have the doctors told you so far?
E1, especially on a ward or after a referral.Would it help if I explained a bit more about how it works?
Asking permission to give information.I'll explain this in a couple of steps, and please stop me at any time.
Setting up chunking and inviting interruptions.How does that sound so far?
E3, inviting a reaction after a chunk.What are your thoughts on that?
E3, after a suggestion or a piece of news.In other words, it's swelling caused by extra fluid.
Explaining a medical word straight after you use it.Just so I know I've explained it well, could you tell me what you'll do if the pain comes back?
E4, teach-back on a key instruction.Which part would you like me to go over again?
E4, inviting the patient to say what was unclear.Is there anything else you'd like to know about the operation?
E5, checking for further information needs.Some people like to know about the recovery time as well. Would that be useful?
E5, offering information they may not think to ask for.I can also give you a leaflet so you have this in writing.
Supporting the verbal explanation.
Weak vs better, and the 5-minute picture
After a heart attack you need to take aspirin and your other tablets every day, no driving for a while, no heavy lifting, go to cardiac rehab and call an ambulance if you get chest pain. Do you understand?
Yes.
One long block, no starting point, no pauses, and a yes/no check that tells you nothing.
Before you go home, what have the doctors told you about your medicines?
Just that there are a few new ones.
Okay. Let's take it in three parts: your medicines, getting back to activity, and what to do if you get chest pain. First, the medicines. Each one has a job, and the most important thing is to take them every day, even when you feel well. How does that sound?
That's a lot of tablets.
It is a lot at first, and that's a common worry. We can write you a simple chart. Shall we do that together?
Starts from what he knows, announces chunks, pauses for a reaction and responds to it.
- When a card says "Explain...", "Advise..." or "Reassure...", plan two or three chunks, not ten facts.
- Pause after each chunk and respond to whatever comes back.
- Use teach-back once for the most important instruction.
- Before closing, ask if there is anything else they want to know.
Check yourself
4 quick questions. Tap an answer to see why.
1 Which is the best way to check understanding of a key instruction?
2 What should you do before explaining a diagnosis?
3 Which sentence best shows E3?
4 Which explanation is most appropriate for a patient?