Why this criterion is different
Most candidates are good at medical content. This criterion is not about content. It asks: did you find out what this person believes, what worries them and what they want, and did you use that in what you said next? A B grade usually needs around 2 out of 3 here (approximate). In our words, it has three observable behaviours:
| Indicator | What the listener hears |
|---|---|
| B1 Eliciting ideas, concerns and expectations | You ask what the patient thinks is going on, what worries them, and what they hoped would happen today. Then you listen to the answer. |
| B2 Picking up cues | The patient drops a hint ("My sister had the same thing...", "I can't afford to be off work"). You notice it and ask about it. |
| B3 Relating explanations to their perspective | When you explain, you refer back to their words: "You mentioned you were worried about..." |
In role-plays, the interlocutor's card often contains a hidden worry or belief that only comes out if you ask or respond to a hint. If you never ask, you miss the centre of the scenario.
B1: ask about ideas, concerns and expectations
Think of three separate questions. You do not need all three in every role-play, but you should hear at least one or two from yourself early on.
- Ideas: what the patient thinks is causing the problem. "What do you think might be behind these headaches?"
- Concerns: what they are afraid of. "Is there anything in particular that's worrying you about it?"
- Expectations: what they want from you. "What were you hoping we could do for you today?"
Doctor. A patient with newly diagnosed type 2 diabetes is reluctant to start tablets.
You need to start metformin. It's the standard first-line treatment.
Before I go into treatment, could I ask what you already think about taking tablets for this? Some people have strong feelings about it.
Why: The better version invites his beliefs first. If he says "Once you start, you can never stop", you now know what to address.
B2: hear the cue and follow it
A cue is a small signal that something matters more than the words suggest. On a recording, cues are verbal: a mention of a family member, money, work, a past bad experience, a hesitation, or a repeated word. The skill is to stop and ask about it, instead of continuing with your list.
Nurse. A man with chest pain is being discharged after a heart attack.
Patient: "I'm just worried because my dad died of a heart attack at fifty-two." Nurse: "Okay. Now, about your medications..."
Patient: "I'm just worried because my dad died of a heart attack at fifty-two." Nurse: "That must make this feel very frightening. How old are you now, if you don't mind me asking? And what's going through your mind about it?"
Why: The better response acknowledges the emotion and explores the cue. This is where the real conversation is.
- Family: "My mum had this too." Ask what happened to her.
- Work and money: "I'm self-employed." Ask how the illness affects work.
- Past experience: "Last time I was in hospital..." Ask what happened.
- Repetition: the same word twice ("I'm fine, really, fine"). Gently check: "You said fine a couple of times. How are you really finding it?"
B3: link your explanation to what they said
This is the part candidates most often forget. You asked about their worry. Now, when you explain or advise, connect it back to that worry by name. This shows the assessor that you used the information.
Doctor. A mother brought her son in because she thinks his cough means asthma, like his cousin.
It's a viral infection. He needs fluids and rest.
You mentioned you were worried this might be asthma, like his cousin's. From what I've heard and examined today, it sounds much more like a viral infection. I'll explain what makes me think that, and what signs would make us look at asthma again.
Why: The better version names her idea, answers it directly, and promises a reason. Her worry is not left hanging.
Phrase bank: the patient's perspective
What do you think might be causing this?
Eliciting ideas, early in the conversation.Has anyone said anything to you about what it could be?
When the patient may have heard opinions from friends, family or the internet.Is there anything in particular that's worrying you?
Eliciting concerns.What were you hoping we could do for you today?
Eliciting expectations, especially when they seem to want something specific.You mentioned your dad. Could you tell me a bit more about that?
Following a family cue.It sounds like work is a big part of this for you.
Reflecting a work or money cue so they can expand.You said earlier that you were worried about side effects, so let me talk about that first.
Linking your explanation to a concern they raised.I know you were hoping for antibiotics, so I'd like to explain why I don't think they'll help this time.
Addressing an expectation you cannot meet.How does that fit with what you were thinking?
After explaining, checking their reaction against their own idea.Does that answer the worry you had about your job?
Closing the loop on a concern.
Weak vs better: a short dialogue
Your scan shows a slipped disc. You'll need physiotherapy.
But I really think I need an MRI. My friend had one and they found something.
An MRI isn't needed. Physiotherapy is the best option.
The patient's expectation (a scan) and the cue (the friend) are both ignored. He will probably stay unconvinced.
But I really think I need an MRI. My friend had one and they found something.
It sounds like what happened to your friend has stayed with you. What did they find, if you don't mind me asking?
A tumour on his spine. I keep thinking that could be me.
That's a really understandable fear. So let me explain what I looked for today that would point to something serious like that, and what I found.
The doctor follows the cue, uncovers the real concern, then links the explanation directly to it.
How it plays out across 5 minutes
- Early (minute 1): after the opening, ask at least one ideas or concerns question before you start explaining.
- Middle: treat every hint as a door. Open it with one short question.
- When explaining: start with their words: "You mentioned...", "You were worried that...".
- Before closing: check whether their original worry has been answered.
Check yourself
4 quick questions. Tap an answer to see why.
1 A patient says, "I can't really be off work, I've only just started this job." Which response best picks up the cue?
2 Which sentence best shows B3, relating your explanation to the patient's perspective?
3 Which question asks about the patient's expectations?
4 You have three tasks left and a patient mentions that her mother had the same illness. What is the best approach?