Opening the Consultation
The opening sets the tone for the entire interaction and is heavily weighted in OSCE marking schemes.
Essential opening steps:
| Step | What to Do | Example Phrase |
|---|---|---|
| Greeting | Warm, professional welcome | “Good morning, my name is…” |
| Introduction | State your name and role | “I’m [Name], the pharmacist here today” |
| Confirm identity | Check patient name and DOB | “Can I confirm your name and date of birth please?” |
| Explain purpose | State why you’re meeting | “I’d like to talk to you about your new medicine” |
| Gain consent | Check patient is happy to proceed | “Is that okay with you?” |
| Establish time | Set expectations | “This should take about 10 minutes” |
The “golden minute”:
- Allow the patient to speak uninterrupted initially
- Resist the urge to jump in with questions
- Listen actively—nod, maintain eye contact
- Patients often reveal key concerns early if given space
Non-verbal communication checklist:
- Appropriate eye contact (not staring)
- Open body posture (no crossed arms)
- Appropriate distance (not too close/far)
- Nodding to show understanding
- Avoid looking at watch or notes excessively
ICE: Ideas, Concerns, Expectations
ICE is a core consultation skill that demonstrates patient-centred care. Examiners specifically look for this.
Why ICE matters:
- Uncovers the patient’s perspective
- Identifies hidden agendas
- Builds rapport and trust
- Leads to better shared decisions
- Improves adherence
How to explore ICE:
| Component | Purpose | Example Questions |
|---|---|---|
| Ideas | What does the patient think is happening? | “What do you think might be causing this?” / “Have you any thoughts about what’s going on?” |
| Concerns | What is the patient worried about? | “Is there anything particular that’s worrying you?” / “What’s your main concern about this?” |
| Expectations | What does the patient hope to achieve? | “What were you hoping we might be able to do today?” / “How were you hoping I could help?” |
Tips for natural delivery:
- Don’t ask ICE as a robotic checklist
- Weave questions into the conversation naturally
- Use the patient’s own words to follow up
- Acknowledge and validate responses (“I understand that must be worrying”)
Common ICE findings and responses:
| Patient Concern | Pharmacist Response |
|---|---|
| Worried about side effects | Provide balanced information; discuss likelihood; explain what to do if they occur |
| Thinks antibiotics are needed | Explore reasoning; explain when antibiotics help/don’t help; offer alternatives |
| Concerned about addiction | Acknowledge concern; explain actual risk; discuss monitoring |
| Wants a specific medicine | Explore why; discuss appropriateness; offer alternatives if needed |
Safety-Netting
Safety-netting ensures patients know what to do if things don’t go as expected. This is a critical patient safety skill.
Components of effective safety-netting:
| Element | Description | Example |
|---|---|---|
| Expected course | What should happen if treatment works | “You should start to feel better within 48 hours” |
| Warning signs | Specific symptoms to watch for | “If you develop a rash, difficulty breathing, or high fever…” |
| Timeframe | When to take action | “If there’s no improvement by Friday…” |
| Action to take | Clear instructions on what to do | “…please come back and see us” / “…call 111” / “…go straight to A&E” |
Safety-netting phrases for OSCEs:
Good (specific):
- “If you develop a temperature over 38°C, severe headache with neck stiffness, or a rash that doesn’t fade when you press on it, call 999 or go straight to A&E”
- “If the pain hasn’t improved in 48 hours despite taking the paracetamol regularly, please see your GP”
Poor (vague):
- “Come back if you’re not better”
- “See your doctor if you’re worried”
Written information:
- Reinforce verbal safety-netting with written information where possible
- Patient information leaflets
- NHS website resources
- Written action plans (e.g., asthma)
Checking understanding:
- “Just to make sure I’ve explained things clearly, can you tell me what you’ll do if…?”
- Use teach-back technique
References
- Royal Pharmaceutical Society, “Consultation Skills for Pharmacy Practice”
- Neighbour R, “The Inner Consultation”
- Centre for Pharmacy Postgraduate Education, “Consultation Skills for Pharmacists”
- General Pharmaceutical Council, “Standards for Pharmacy Professionals”