Lesson 3.3 : Counselling Stations: Understanding Before Explaining

Lesson 3.3: Counselling Stations — Understanding Before Explaining

SPIKES is for catastrophic news. Standard history-taking is for unknown presentations. This lesson covers a third type of station: the patient has a concern, a misconception, a request, or a fear, and your task is to understand it fully before you respond.

When to Use This Approach

Step 1 — Clarify the Concern

Before offering any advice, understand exactly what the patient is worried about and why they are here today.

• "Can I check — what made you want to discuss this today?"
• "Has someone said something, or was there something you read that made you worried?"
• "What are your thoughts about this at the moment?"

Your goal: identify the trigger (article, friend, past experience), understand what the patient believes, and understand what they are afraid of. Do not start explaining until you have done this.

Step 2 — Assess the Background

Gather focused background information that affects the safety and relevance of your advice. The questions depend on the case:

• Pregnancy concern: gestational age, scans, complications?
• Medication refusal: current dose, compliance, side effects experienced?
• Vaccine refusal: any allergies, previous reactions, eligibility?
• Child concern: age, milestones, previous hospital admissions?
• General: any existing conditions, current medications, family history relevant to this concern?

Step 3 — Reassure and Explain

Now give clear, calm, balanced advice, acknowledging the concern before correcting any misconceptions.

Avoid: 'You don't need to worry' or 'It's nothing.' Instead:

• "I can see why that would be worrying. Let me explain how this actually works."
• "There is a lot of information out there — I'll walk you through what we know from NHS guidance."
• "This is actually a very common concern — here's what we usually find."

Explain: what the condition/treatment/test is, why it is recommended, how it works, risks vs benefits, and what evidence supports your advice. Use analogies where helpful. Use patient-friendly language throughout.

Step 4 — Engage in Shared Plan

Offer clear next steps, respect the patient's autonomy, and support whatever decision they reach, including declining the treatment or test.

• "I'll guide you through the options, and you can let me know what feels right for you."
• "We'll take this at your pace — you don't need to decide everything right now."
• "If you'd like more time, or would like to read more first, that's completely fine."

Always include: what you recommend and why, what alternatives are available if they decline, what happens next, an offer of written information or NHS resources, and a clear safety-net.

Common Counselling Station Mistakes