The CSA with Confidence
SCRIPTS AND PHRASES
What are scripts and phrases
- A phrase is a small group of words put in a particular way to help you say, express or enquire about something. They are often put together because other ways of expressing or enquiring about the same thing can appear rather clumsy or less effective.
- Now, you will know what a script is in terms of the acting world – a written text of a play, film, broadcast or performance. But in the General Practice context, we mean a script to be a group of phrases that you might use in your consultation ‘performance’ to help your methodically cover a particular area.
A little word of caution...
These scripts and phrases are provided to help you with your communication skills. But the problem with memorising scripts and phrases is that they can make you end up becoming rather rigid and inflexible in your performance. The world is full of diverse people with diverse and different lives. The dialogue you have with your patient really depends on how much you find out about that patient and their world. Stock scripts and phrases can stop you from doing that and if you’re not careful, they can make you treat individual people as no different to each other. And that then makes your job become mundane and boring until you finally end up not particularly enjoying General Practice. For those preparing for the CSA, did you know that some CSA examiners don’t particularly like well rehearsed commonly known scripts. They don’t like them because they feel some scripts and phrases can make the consultation look artificial or contrived. The CSA examiners are very good at picking up things that sound artificial.
And some patients can pick up on stock phrases too. The biggest one is ICE – Ideas, Concerns and Expectations. Read these two articles…
I’ve been a GP for over 15 years and I still love it. Why? Firstly, because most patients are fundamentally nice people. Secondly, because they have really interesting lives. Thirdly, because I care. Fourthly, because I want to make a difference to individuals and their families and their world. And I cannot do any of that if I don’t treat individuals as individuals. Yes, I do ask very similar questions to different patients and no, I am not saying you need to use a different and unique phrase for each individual. What I am saying is that whilst I use similar questions with different patients, I also know when to TWEAK them to make them more tailored and contextually relevant to the patient sat in front of me. It is this STYLE FLEXIBILITY that makes you truly get into the world of the patient before you. It is this style flexibility which helps you realise that every patient has their own interesting and unique story. And it is this style flexibility that helps make your job as a GP interesting, enjoyable and rewarding. When it is my time to step down from being a GP, I want to look back and say to people: “Yup, I really enjoyed being a GP. I enjoyed that phase of my life and now I look forward to enjoying the next”. Do you aspire for the same?
How to use scripts and phrases
So, what do I recommend?
Let’s not forget, scripts and phrases are powerful tools that can help you cover areas of a consultation with ease and efficiency. Here is some guidance to help you use themwithout them making the consultation look artificial and clunky.
- If you are relatively new to General Practice, then use the scripts as a starting point. They should help give you some idea of what to say. Yes, you may want to start memorising these scripts and phrases and using them on as many patients as you can. Memorise and use them until they become easy to reel off you tongue without you thinking about them too much. Initially, practice with only one or two scripts a week. After a couple of months, you will have familiarised yourself with most of them.
- But once you are familiar with them, I would like you to tweak them to suit your own personality and style rather than mine. Play about with them in your day-to-day consultations and modify them until you get a phrase of your own that fits in with your personality and style. Again, practise with only one or two scripts a week. After a couple of months, you will have perfected your own version of all of them.
- And then, when you have your own set of stock scripts and phrases, I would then like you to start tweaking them even more – but this time tweaking them in a way to make them more contextually relevant to the patient sat in front of you and the story they have divulged so far.
- In other words, use stock scripts and phrases as help tools. Help tools to help you develop a true natural conversation. A truly natural conversation is where each person responds to what each other has just said in a helical fashion. In a truly natural conversation, you cannot second guess what or how the conversation will go. It depends on this repeated to-and-fro response to each other.
A couple of other points
- Some of the scripts might at first glance appear unnecessarily lengthy to you. Bear in mind that these lengthier phrases will still only take about 5 seconds to say! But that extra small amount of extra wording makes the world of difference in aiding communication, data gathering and explanations. Trust me.
- Don’t routinely ask about every script provided here or in a particular sequence. Let’s look at a plumber analogy. If you call a plumber out to fix something in your house – he or she will not use every single tool in their toolbox to fix your problem. They will only use the right tools for the particular job. In a similar way, all of these scripts and phrases are tools too – your consultation tools. Again, only use those scripts and phrases that are appropriate to use. How do you determine which are appropriate? Simple – listen to the patient’s story and follow it. Then, use scripts and phrases at points where they naturally fit into the story to help elaborate it.
Sometimes patients don't tell you everything straight away..
Remember, not all patients tell you everything straight away
Yes, it’s true. Many patients won’t tell you everything straight away, especially when you’re exploring their ideas, concerns and expectations (ICE). If you ask them directly about their ICE at the beginning of the consultation, they may just say “nothing really” or shrug their shoulders. Nearly all patients will have some ideas, concerns or expectations but they don’t share them straight away because…
- It is sensitive territory. Sensitive areas require some rapport-building first before people are willing to divulge information more freely.
- Some patients worry that their ideas, concerns and/or expectations might look stupid to the doctor and they don’t want to look stupid in front of the educated doctor. (understandably)
- Some patients are embarrassed to divulge their ideas, concerns and/or expectations.
- Some patients don’t know how to vocalise what they want to say and need help from you.
Here are some tips to get patients to open up
- Try and ask about ICE a little bit into the consultation when you have managed to develop some rapport. So be nice and be attentive. Show them you want to help.
- A patient is more likely to divulge information if you also create an atmosphere where their input is more than welcomed. So, be nice, kind and compassionate.
- Tell them how important their opinions matter.
- Tell them that in order to understand them better that you’d like to know what they think.
- And of course, always reassure them if they say “I don’t want to sound silly”.
In a consultation, if a patient says ‘nothing really’, consider re-framing and re-phrasing your question and perhaps ask it a little later on once rapport has established itself more fully. For instance….
- Doctor: “And have you had any thoughts as to what might be going on?”
- Patient: “not really” (PS not really means yes!!)
- Doctor: “Not really? Sounds like there might be something?”
- Patient: “Well it might sound silly but I was talking to my friend and she said….”
- Doctor: “And have you had any thoughts as to what might be going on?”
- Patient: patient shrugs
- Doctor: “For example, has someone said anything to you about it or have you read anything on the internet or a magazine?”
- Patient: “Well I have to admit, I did do a bit of an internet search. I know you’re not suppose to but…”
Please leave a comment below if you have any words of wisdom to help others or if you have any questions you wish to ask…