The Patient's Narrative & Narrative Consultations
Because every patient has a story — and the diagnosis is usually hiding somewhere inside it.
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Handouts, teaching slides, and reflective stories — ready when you are.
path: NARRATIVE MEDICINE
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A hand-picked selection of official guidance and real-world GP training resources. Because sometimes the best pearls are not hiding in the official documents.
⚡ Quick Summary — One Minute Recall
What Is Narrative Medicine?
Narrative medicine was formalised as a discipline in the early 2000s by Dr Rita Charon at Columbia University, New York. It is now a central concept in modern general practice and medical education worldwide.
Narrative medicine is an approach to clinical practice, research, and education that uses patients' narratives to promote healing. It addresses the relational and psychological dimensions of illness alongside physical disease — with an attempt to deal with the individual stories of patients.
In GP, narrative medicine means allowing patients to tell their story in their own way — and genuinely listening to it. It validates the patient's experience, encourages self-reflection in the doctor, and almost always produces a more accurate clinical picture than a list of closed questions ever could.
The Two Ways of Data Gathering
Every time you see a patient, you choose — consciously or not — which approach you use. The comparison below shows what each one actually produces in practice.
| ❌ The Tick-Box Approach (Doctor-Centred) | ✅ The Narrative Approach (Patient-Centred) |
|---|---|
| Also known as | |
| Question-answer method; interrogation model | Story-telling approach; conversation model |
| Who controls it? | |
| The doctor. You guide, you direct, you interrupt. | The patient leads. You follow with genuine curiosity. |
| Data quality | |
| Fragmented. You only get the jigsaw pieces you think to ask for. | Rich and connected. The patient gives you pieces you didn't even know to look for. |
| What gets missed? | |
| The unexpected, the emotional, the contextual — the things that change the clinical direction. | Very little. The patient volunteers the crucial information when they're allowed to talk. |
| Biochemical effect (on both doctor and patient) | |
| Devil's Cocktail: adrenaline + cortisol → narrowed thinking, irritability, missed details | Angel's Cocktail: dopamine + oxytocin + endorphins → sharp thinking, connection, creativity |
| The chest pain example | |
| "Sorry to cut you short — was the pain sharp or dull? Where was it? Did it go to your arm?" You miss what the patient was about to say next. | Patient says: "I don't know if this is important, but my aunt died of a clot in the lung and she had a funny blood disorder." You now know to explore the PE route. |
| Risk to the patient | |
| High. A wrong diagnosis follows a fragmented history. | Low. The narrative is itself a form of protection against error. |
| How it feels to the patient | |
| Like a questionnaire. Patients feel processed, not heard. | Like a proper conversation. Patients feel genuinely understood. |
The Angel's Cocktail vs The Devil's Cocktail
This is not metaphor — it is neuroscience. The approach you use in your consultation changes the biochemical environment in both you and your patient. And that biochemical environment changes everything: your thinking, your empathy, your diagnostic accuracy, and your patient's willingness to share.
😇 The Angel's Cocktail — Narrative Approach
😈 The Devil's Cocktail — Tick-Box Approach
A Masterclass in Narrative — The MND Story
This is a real clinical story. Read it carefully — not just for the diagnosis, but for the exact moments where the narrative changed everything.
I once saw a patient who had already seen three other doctors about being a little 'off his feet' and he wondered whether it was due to an injury he had at work several months before. The other doctors got pulled in by this and agreed with him and told him things would get better and time — the healer — needed to do its thing. But months had passed and his wife was getting frustrated, so she made him come and see the doctor again — this time me.
I simply allowed the patient to tell his narrative. Again, he said it had been going on for 8 months and again he said 'I suppose it takes time for things to settle after the injury I had.' I think he basically wanted me to agree with him and probably did the same to the previous doctors. The events around the injury went something like this: a heavy pallet nearly fell on him at work and he quickly and abruptly jumped out of the way and landed with a heavy fall. Luckily the pallet missed him.
But what made me sit up and listen was that he said that over the last 6 months he sometimes had to be guided by his wife in which direction to walk. Again, he said 'I suppose these things take time to heal.' And I asked him to explain more and simply gave him space. He said: 'Sometimes, I can't walk directly somewhere and I start veering off. It's not too bad though — my wife just needs to hold me and then I'm okay.'
This was the second or third time that he was belittling his problems. It crossed my mind whether he was scared and whether he actually knew this spelt something more sinister. From that moment on, the wise voice inside my head was telling me to SLOW DOWN in my history taking and data gathering.
He ended up with Motor Neurone Disease.
But the thing I want you to notice is that it was his narrative that stopped me from saying "Yeah, injuries take a while to recover from." It was his narrative that made me stop and worry. It was his narrative that made me refer him. It was his narrative that made me do something different to the other doctors. It was his narrative that made me do the right thing.
And subsequently? This patient came to see me again — not because I got the right diagnosis. He said it was because he felt he could be at ease and talk freely. That rapport was effortless, born from natural curiosity and a genuine desire to understand the psychosocial impact of his problem. And the thing that made all of this possible was simply employing the narrative approach.
- He belittled his symptoms — repeatedly. That pattern is the signal. Patients who minimise often know something is wrong and are frightened of what it might mean.
- "I start veering off." This is not musculoskeletal. A tick-box approach looking for injury-related symptoms might never have surfaced this.
- The narrative made Dr Ram slow down. Not medical knowledge — the story. It triggered the internal clinical voice to recalibrate.
- The previous doctors were not bad doctors. They answered the question the patient was asking. The narrative approach answers the question the patient couldn't quite bring themselves to ask.
- When a patient repeats something — especially to minimise — pay more attention, not less.
- The narrative builds rapport effortlessly. No technique required. Just genuine curiosity.
- In a litigious age, the narrative is also your protection. Three missed diagnoses here could have resulted in a different outcome.
Benefits of the Narrative Approach
The narrative is powerful for both parties in the consultation. Here's what it actually does — broken down honestly for both the patient and for you.
👂 Feels listened to
When patients feel heard, they open up further — giving you more clinical data than you would have gathered through questioning alone.
🌡 Therapeutic in itself
Being allowed to talk is an emotional steam valve — "the patient's lament." Ventilation of feelings is a form of therapy. Patients often leave feeling better simply from having been heard.
🌱 Builds resilience
Storytelling helps patients become more centred and grounded. It contributes to emotional health, stability, and wellbeing — especially in those dealing with chronic illness or loss.
🤝 Builds rapport — effortlessly
Genuine curiosity builds trust without technique. Patients don't know you're "using narrative medicine" — they just feel genuinely understood by their doctor.
🧩 Helps patients make sense
The story helps patients construct meaning from confusing or traumatic events — divorce, violence, loss, illness. Telling it helps them come to terms with it.
🔍 Self-discovery
Patients discover things about themselves through the stories they tell — their identity, their values, their relationships. It helps them reflect on who they are.
🎯 More accurate picture
A fuller, richer history leads to more relevant follow-up questions, a clearer differential, and ultimately a better diagnosis.
📋 Better management plan
The most accurate diagnosis leads to the most appropriate plan. The narrative feeds every downstream clinical decision.
🛡 Protection from error
The narrative protects you from making mistakes. In a litigious age, the doctor who genuinely listened and understood the full story is the one who did the right thing — and can demonstrate it.
🧠 Deep learning
Good stories stick in your mind forever. You learn MND not from a textbook but from that patient. That's the kind of learning that survives 20 years and a night shift.
🌉 Bridges gaps
The narrative can bridge opposing beliefs between patient and doctor, and across families. It's one of the few communication tools that softens genuinely hard conversations.
❤️ Sense of purpose
The narrative propels you to give time to what matters and do the right thing. It is one of the things that keeps good GPs in the room — both physically and professionally.
The Cortazzi Model — How Patients Tell Their Stories
Cortazzi (1993) identified 6 phases in the structure of oral storytelling. Knowing these phases helps you understand where a patient is in their story — and how to follow rather than interrupt at the wrong moment.
Initiates the narrative. Gives a summary or general proposition. Sometimes triggered by the doctor's opening question.
The patient elaborates on themselves, others in the story, the setting, and the time period. This is where you begin to understand the cast and context.
The central events of the story. The bones of it. Problems, crises, turning points — and the patient's sense-making of those events. Often in the past tense.
The patient evaluates what they've told you. This is where ICE often crystallises. Their concerns and expectations become explicit here if you haven't already uncovered them.
The outcome or resolution. Sometimes this is the patient reaching a decision — often with gentle facilitation from you. The plan begins to emerge naturally here.
Marks the end. Speech returns to the present tense. The patient leaves the consulting room — figuratively and literally. This is your natural safety-netting and closing moment.
Analysing the Patient's Narrative — What To Listen For
How a patient tells their story contains as much clinical information as what they tell you. Learning to analyse the structure and language of the narrative is one of the more sophisticated — and rewarding — consultation skills a GP can develop.
Based on the frameworks of Reissman (narrative analysis) and Leiblich et al. (1998). Expand each section below.
Focus on the meaningful themes of the story. What is the patient really talking about? What are their ideas, concerns and expectations as they emerge through the narrative?
- Allow the patient to express their thoughts, feelings, and what they expect from you
- Gently allow the psychosocial-occupational story to unfold without forcing it
- Does the story make sense? If there are gaps or inconsistencies — explore them. There's usually a reason they exist.
- Are big chunks of the story being left out? Patients often omit the most emotionally charged parts. If something feels missing, gently invite it: "Is there anything else about all of this you haven't mentioned yet?"
- Does the story add up? If a patient's explanation of their symptoms doesn't quite fit their history, the narrative itself is telling you something clinically important.
Most patient narratives follow one of four classic story plots. Recognising which plot you're in changes how you engage with the patient.
Patient faces serious challenges en route to a goal — and eventually succeeds. For example, the patient who overcomes a serious illness and returns to full life. The story has a heroic arc. Your role: witness and support the journey.
Social disorder of some kind — massive change at work, family upheaval, new baby, bereavement. The goal is restoration of order and equilibrium. Your role: help them find a path back to stability.
The patient is defeated or excluded — from work, family, community, or from receiving what is due to them. They may feel marginalised, unseen, or systematically failed. Your role: validate, empower, advocate where you can.
A cynical, outsider perspective — criticising social norms, institutions, or hierarchies. The patient is stepping back from their situation and commenting on it. Your role: listen without judgement; help them find agency within the system they're critiquing.
The words a patient uses are clinical data. The structure of their language carries meaning beyond the literal content. These are the cues — deliberately cultivate the habit of noticing them.
| Linguistic Cue | What It May Mean | Clinical Application |
|---|---|---|
| Repetition | Emotional emphasis. The patient is trying to underline something important — consciously or not. | Pay more attention when a patient repeats themselves, not less. Ask: "You've mentioned that a couple of times — it clearly matters a great deal." |
| Adverbials like "suddenly" | Indicates how expected or unexpected events were to the patient. | Helps you gauge the emotional impact and how much sense-making they've had time to do. |
| Mental verbs: "I thought", "I noticed", "I understood" | Indicates the extent to which an experience is in conscious awareness and can be recalled. | A patient using few mental verbs may be dissociating or avoiding emotional processing. |
| Past tense throughout | Patient is distancing themselves from the event — creating psychological space from it. | This can be adaptive (processing) or avoidant. Follow up gently: "How does it feel now, looking back at all of that?" |
| Passive voice: "It was done to me" / "I was told" | May indicate the patient feels a lack of agency — things happen to them rather than being shaped by them. | Opportunities for shared decision-making may be especially powerful here — restoring a sense of control. |
| Active voice: "I decided", "I made" | Patient has a strong sense of agency. They are the author of their story. | Build on this — collaborative management plans work very well here. |
| Digressions or sudden topic shifts | May indicate avoidance of a painful subject. The shift itself shows the patient knows something is difficult to approach. | Don't ignore the topic they moved away from. Gently revisit it: "You moved on quickly just then — is that something you're happy to come back to?" |
| Detailed descriptions (long physical accounts) | May indicate a reluctance to describe the emotional dimension — the patient hides in the factual. | After letting them finish, gently invite the emotional: "You've described all of that very clearly. How has it been making you feel?" |
| Minimising phrases: "It's not that bad", "I suppose it's nothing" | Potentially significant — especially repeated. The patient may be frightened of what the symptoms might mean. | From the MND story: this pattern was the signal that the diagnosis was serious. Slow down. Explore further. |
Some patients tell you the whole story in one go (holistic). Others share it in instalments across multiple consultations (categorical). Both are valid — but each requires a different response.
Gives you the complete picture in a single consultation. These patients are often ready to process and decide. Benefit: you can make a comprehensive plan. Risk: information overload — ensure you have gathered the most important elements.
Shares the story in segments across several visits. These patients need time and safety. Benefit: each consultation goes deeper. Risk: if you only see them once, you get an incomplete picture. Always consider: what might they not be saying yet?
Using a Consultation Framework Without Killing the Story
No — not at all. There is nothing wrong with consultation frameworks. The problem is not the framework; it is the rigidity with which many trainees use it.
The trainee treats the framework as a rigid protocol — a sequence of tasks to be ticked off in order. If the patient goes somewhere unexpected, they say "we'll come back to that" and bulldoze on. The interaction becomes a survey. No story ever develops.
The framework sits in the background as a guide-map. It gently provides direction. But when the patient goes somewhere interesting and relevant, you follow them. When that thread is complete, you pick up the guide-map and see where you are.
- 1Open question / golden minute — invite the story; don't interrupt it
- 2ICE — Ideas, Concerns, Expectations — let these emerge from the narrative where possible; weave in the questions when the moment is right
- 3PSO — Psychosocial story — often emerges naturally from the narrative; allow it rather than asking for it directly
- 4Confirm drug history and past medical history — a more closed section, but still done conversationally
- 5Closed questions and red flags — weave these in where they fit naturally in the story; don't fire them as a list
- 6Examination if needed
- 7Relate back to ICE — link your findings and plan to what the patient actually said and worried about
- 8Discuss the diagnosis / explain
- 9Options for treatment — shared decision-making — the management narrative, built together
- 10Follow-up and safety-netting
- The trainees who score lowest in the SCA are usually those who follow their framework in the most rigid way — generating a long series of doctor questions and patient answers with no actual story ever forming.
- The patients who feel most satisfied with their consultation are not the ones who got the most questions answered — they're the ones who felt most genuinely heard.
- With a patient who rambles extensively, a slightly more structured approach is fine — but even then, use the framework with a lighter touch than you think you need to.
- Always ask yourself: "Am I following the patient or dragging them?" If you're dragging, slow down and give back control.
Teaching Pearls — How To Teach the Narrative Approach
The narrative approach is one of the harder consultation skills to teach because it resists being broken down into steps. It is fundamentally an attitude — curiosity, patience, and genuine interest in the person in front of you. These teaching suggestions help trainees find and develop that attitude.
- Mistaking silence for failure. Many trainees rush to fill pauses with questions. Teach them: silence is the patient thinking. It is productive. Wait for it.
- ICE as a checklist. Trainees often treat ICE as three tasks to accomplish in sequence. Help them understand that ICE is a state of mind — genuine curiosity about what the patient thinks, fears, and wants.
- Framework rigidity. The trainee follows their favourite framework so rigidly that no story ever forms. Ask them in COT debrief: "At what point could you have followed the patient rather than your framework?"
- Not noticing repetition. When a patient repeats themselves, most trainees do not register it as a signal. Explicitly teach this: repetition = emphasis = follow it.
- Minimising responses from patients. Teach trainees that when a patient says "it's probably nothing", this is not permission to move on — it is an invitation to slow down.
Watch a recorded consultation together. Pause at each moment where the trainee could have followed the narrative but chose to interrupt instead. Ask: "What did the patient seem to be heading towards? What did they get instead?"
Ask the trainee to conduct a consultation using only open questions and reflections for the first 3 minutes. No closed questions allowed. Debrief: what information did they get that they wouldn't have sought directly?
After a consultation, ask the trainee to identify which Cortazzi phases the patient went through and where they were when the consultation ended. Did they reach Evaluation? If not — why not?
Play a short recording of a patient. Ask the trainee to list every linguistic cue they notice — repetition, passive voice, adverbials, tense shifts. Compare what they found versus what was actually there.
- "Tell me about a patient this week whose story surprised you — whose narrative went somewhere you didn't expect."
- "What was the moment in that consultation where you felt most genuinely curious about the patient?"
- "Was there anything in a recent consultation that the patient repeated? What did you make of it at the time?"
- "When did you last follow a patient down an unexpected narrative thread — and what did you find?"
- "Think of a consultation that felt like an interrogation. What would you do differently using the narrative approach?"
What Trainees Really Say — Insights from Across UK GP Training
This section draws on recurring themes from UK GP trainee experiences, published trainee accounts, UK GP educator courses, deanery toolkits, and peer-reviewed research on consultation skills — all cross-checked against RCGP guidance. Nothing here conflicts with official advice. All of it is the kind of insight that takes months of clinical experience to discover — or seconds to read here.
Research published in the British Journal of General Practice describes all GP consultations as having three natural parts. Understanding this structure makes the narrative approach instantly practical.
The Patient's Part
The Doctor's Part
The Shared Part
The single most reported reason for failing the SCA is not poor knowledge — it is poor time allocation. Trainees spend 9 minutes gathering data and have 3 minutes left for the management plan. Here is what the time split should look like.
One of the most consistent themes from experienced UK GP educators is this: the biggest ICE mistake is treating it as three tasks to tick off rather than three windows into the patient's inner world. Here is what that actually looks like in practice.
- ✗ Feels like a survey
- ✗ Asked all at once, out of context
- ✗ Patient hasn't built enough trust to answer honestly yet
- ✗ Examiner sees the consultation technique, not the person
- ✗ Responses are often shallow or dismissive ("not really")
- ✓ Each ICE element asked at the right moment in the story
- ✓ Triggered by what the patient says, not by your checklist
- ✓ Patient feels genuinely listened to
- ✓ Responses are richer, more honest, more clinically useful
- ✓ The examiner sees a natural human conversation
These are the patterns that appear consistently in trainee accounts, course feedback, and study group debriefs across UK GP training programmes. None of them are about knowledge. All of them are fixable.
Across published trainee accounts, study group debriefs, and experienced UK GP educator observations, certain behaviours separate the trainees who score well from those who struggle. None of these require exceptional clinical knowledge. All require deliberate habit-building.
These insights come from UK GP trainers, training programme directors, and deanery-endorsed resources. All align with RCGP guidance. All are the kind of teaching that trainees describe as changing how they consult.
One of the most consistent pieces of advice from experienced UK GP trainers and TPDs: when the patient drops a cue — a hesitation, a repeated phrase, a mention of a family member's illness — follow it. Don't say "we'll come back to that" and carry on. The cue is almost always more important than the next question on your list. The narrative lives in the cues.
The best GP consultations are not performances of a prepared script. They are improvised dances between structure and spontaneity — between guiding and following. By letting go of the rigid framework and focusing on genuinely being with the patient, something shifts. The consultation flows. The patient opens up. The examiner sees a real human interaction.
A simple framework used by experienced UK GP educators for handling moments of emotional difficulty in the consultation. When the patient becomes upset, worried, or tearful: first Acknowledge what they've said ("I can hear how difficult this has been"), then Empathise genuinely ("That must have been frightening"), then Energise — direct the consultation forward collaboratively ("Let's think together about what we can do"). This sequence keeps the consultation moving without dismissing the emotion.
When you face a genuine clinical or ethical dilemma in the consultation, say so. "I want to be honest with you — I'm weighing up a couple of options here, and I'd like to talk through them with you." This scores in multiple domains simultaneously: it demonstrates clinical reasoning, genuine patient partnership, and communication transparency. Trainees who keep their dilemmas silent lose marks they could easily have gained.
Research into narrative-based primary care identifies curiosity as the single most transformative quality in a GP consultation — the ingredient that turns an information-gathering exercise into a therapeutic conversation. Curiosity is what makes the follow-up question feel natural, what makes the patient feel genuinely understood, and what keeps your clinical thinking sharp and open. It cannot be faked. It can, however, be cultivated.
Research consistently shows that doctors fail to pick up patient cues — not because they aren't listening, but because they are focused on their own clinical agenda. ICE will often surface during attentive listening as cues that need to be picked up, rather than as clear direct statements. A patient who says "I just don't want it to be anything serious" is giving you the concern. You do not need to ask the question. You need to respond to it.
These are the phrases that consistently appear in the accounts of trainees who have passed the SCA — specifically the ones they describe as having felt natural under exam pressure, rather than scripted. Several are refinements of standard ICE and narrative phrases that trainee feedback has shown to land particularly well with role-players.
🎯 SCA Tips — Narrative, ICE, PSO & Shared Decision-Making
The SCA assesses three domains: Data Gathering, Clinical Management, and Relating to Others. The narrative approach, used well, naturally serves all three at the same time. Here's how to put it into practice within a 12-minute consultation.
The golden minute is the most underused and most valuable minute in the SCA. Trainees who skip it to start firing questions almost always regret it. The examiner is watching from the very first second — and they can tell within 90 seconds whether you are going to allow the patient's story or suppress it.
- Use a single, open, warm invitation — and then genuinely wait. Resist the urge to fill the silence.
- Non-verbal signals matter enormously in a video consultation: lean slightly forward, nod gently, maintain eye contact.
- If the patient hesitates or seems unsure where to start, just stay warm and open. Don't rescue them with a closed question.
- In an audio-only consultation: your voice becomes everything. Speak slowly, warmly, and leave clear pauses for the patient to fill.
ICE — Ideas, Concerns, and Expectations — is where a huge proportion of SCA marks live. But examiners can tell in an instant when it's being ticked off rather than genuinely explored. The narrative approach makes ICE feel natural because it treats each element as a genuine enquiry into the patient's inner life, not a box to tick.
What to do instead:
- Let the narrative bring ICE to you. Most patients, if given space, will volunteer their main concern within the first two minutes.
- When you hear something that sounds like a concern, reflect it back before exploring it further.
- Ask each ICE element at the natural point in the conversation where it belongs — not all at once at the end.
- If ICE hasn't fully emerged by the midpoint of the consultation, that is the moment to gently invite it.
PSO — Psychological, Social, and Occupational context — is not a separate section of the consultation. It is part of the patient's story. When patients tell their narrative, PSO emerges. Your job is to create the conditions for it to emerge, not to interrogate the patient about their social life.
- Often a single open question ("How has all of this been affecting things for you generally?") surfaces both the psychological and the social in one go.
- Pick up on cues: if a patient mentions work, home, a family member — follow that thread briefly before returning to the clinical narrative.
- In the SCA, examiners look for whether you understand the patient as a whole person. The PSO dimension is what demonstrates that you do.
- For IMGs especially: asking about home life, relationships, and work is not prying in UK GP. It is expected. It is essential clinical data.
The management plan is not a monologue. It is the final chapter of the story — and it should be written together. After all the gathering and exploring, the shift to shared decision-making is when you invite the patient to become the co-author of what happens next.
- Always link your plan back to what the patient said. This is the most powerful move in the consultation: "You mentioned you were most worried about X — the good news is…"
- Present options, not instructions. The patient should feel they have genuine choice, not a prescription handed down.
- After presenting your thinking, invite theirs before assuming agreement.
- If the patient seems uncertain about an option, explore that rather than pushing through it.
- Shared decision-making is a skill, not a phrase. It is demonstrated through the quality of the conversation, not by saying "let's make a shared decision."
- Opening the consultation with a warm, single, open question and then genuinely waiting — examiners can see this immediately and it scores from the very first exchange.
- When the patient gives you their concern, reflect it back before doing anything else. Even a single "That sounds really worrying" before continuing scores in the Relating to Others domain.
- Linking your management plan back to the patient's stated concern is one of the highest-scoring single moves in the SCA. Almost no one does it consistently under exam pressure.
- If a patient minimises their symptoms — go slower, not faster. This is a signal, not a reassurance.
- Don't ask "What are your ideas, concerns, and expectations?" — ask them one at a time, naturally, at the right moment in the story.
🗣 Consultation Phrases — Getting the Narrative, ICE, PSO & The Plan
These phrases are designed to be used naturally — not recited. Read them once and let them become part of how you talk. They are designed for real consultations and for the SCA. Notice they are not scripted — they invite, they follow, they collaborate.
- How can I help you today?
- Tell me what's been going on.
- What's brought you in to see me?
- I've had a look at your notes — but I'd love to hear it in your own words.
- Take your time — tell me as much as you'd like.
- What did you think might be causing this?
- Did you have any thoughts yourself about what might be going on?
- What brought you in today rather than, say, last week? — (this is a beautifully indirect way of surfacing the real concern)
- Is there something specific about this that's been on your mind?
- Had anything crossed your mind about what this might be?
- What's worrying you most about this?
- Is there something specific you were worried it might be?
- What's been making you most anxious about all of this?
- I want to make sure I understand what's most on your mind.
- Is there anything about this that's frightened you?
- What would feel most helpful to you today?
- What were you hoping I might be able to do for you?
- Is there anything particular you were hoping we'd be able to sort out today?
- Given everything you've told me — what would make you feel you'd left with what you needed?
- How has this been affecting things for you generally — day to day?
- Has it had any impact on your work at all?
- How are things at home at the moment?
- How are you managing with all of this?
- Is there anyone at home who's been supporting you through this?
- How have you been in yourself generally — aside from this specific problem?
- That sounds really difficult.
- I can understand why that would worry you.
- That must have been frightening.
- It makes complete sense that you're concerned about this.
- Thank you for telling me that — I can hear how much this has affected you.
- That's clearly been a really hard time for you.
- I'd like to explain what I think is happening — and then I'd love your thoughts on the best way forward. Does that work?
- You mentioned earlier that you were most worried about X — let me address that first.
- Based on everything you've told me, this fits with… — and here's what I'd suggest we do about it.
- There are a couple of options here — let me talk you through them and we can work out what suits you best.
- Given what you've told me about your situation, which of those options feels more right for you?
- Is there anything about either of those options that concerns you?
- What would make this easier to manage for you?
- Tell me more about that.
- Can you say a little more about what you meant by that?
- That's interesting — what happened next?
- You mentioned [X] just then — I'd like to come back to that if we can.
- You passed over that quite quickly — is that something you're happy to say a bit more about?
- How did that make you feel at the time?
- If things don't improve in the next [X days], I'd like you to come back.
- If you notice [X, Y, or Z], please come back sooner — or call 111 if you're worried.
- Come back if you're worried at any point — that's exactly what we're here for.
- Does everything we've talked about today make sense?
- Is there anything else you wanted to cover before we finish?
- Do you feel okay with the plan we've made together?
❓ FAQ — Quick Questions
- Data Gathering: the narrative surfaces more relevant clinical information than closed questioning alone
- Clinical Management: a management plan that references what the patient actually said demonstrates integrated, patient-centred thinking
- Relating to Others: the narrative approach is itself the most powerful way to demonstrate empathy, rapport, and genuine patient-centredness — the examiner can see it in your body language, your pacing, and your responses to cues
🏁 Final Take-Home Points
- The narrative is the patient's story told in their own way. Your job is to invite it, follow it, and genuinely engage with it — not to direct it.
- The tick-box approach gives you fragments. The narrative gives you the picture. One leads to the right diagnosis. The other leads to what you were expecting to find.
- ICE and PSO are not separate tasks to accomplish — they are part of the story. Let the narrative bring them to you.
- When a patient repeats themselves, the story is trying to tell you something important. Slow down. Explore.
- When a patient minimises their symptoms, that pattern is the signal. It is not permission to move on.
- The Cortazzi Model (Abstract → Orientation → Complication → Evaluation → Result → Coda) is a map of how stories are told. Knowing where the patient is in their story tells you when to follow and when to gently redirect.
- The narrative produces the Angel's Cocktail — dopamine, oxytocin, endorphins — in both you and your patient. It sharpens your thinking and builds trust at the same time.
- In the SCA, link your management plan explicitly to what the patient told you. This is one of the highest-scoring single moves in the exam — and one of the most neglected under pressure.
- Shared decision-making is the final chapter of the narrative — written together. Present options, invite responses, and build the plan as co-authors.
- The narrative protects your patients and it protects you. In a litigious age, the doctor who genuinely listened and understood the full story is the one who did — and can demonstrate they did — the right thing.
TED talks on the narrative
Rita Charan shows you how she does narrative medicine. I absolutely love her two examples at 7:40 and 10:20.
Sayantani DasGuptas makes a great case for why we should think about narrative competence and not just clinical competence. I couldn’t agree any more.
The theory behind the narrative approach
In this video, Graham Gibbs from the University of Huddersfield talks about the use of narratives in speech and research analysis. At first, I thought “what has my job as a GP got to do with data analysis of the narrative?” but then I came to realise, that is exactly what GPs do! Okay, so Graham in this video is talking about the analysis of the narrative for his students studying ‘Qualitative Data Analysis’, but the fact is – we as GPs do the same on a daily basis – except in a less formal and less research sort of way. What he has to say in this lecture is extremely thought provoking. To us GPs, it gives some idea of the different ways we can analyse the story the patient is telling us. For example, Gibbs advises his students that if a person repeats part of a story, then that person is trying to emphasise that part of the story and the students should take note. The same is true of our patients. I hope, when listening to this video, you will learn a lot of things that you can transfer to your daily GP practice which will hopefully transform your practice to a completely new and wonderful level.