Lesson 2.4: Delivering the Diagnosis, Management Plan, and Shared Decision-Making
The second half of the consultation — from the 4-minute transition onward — is where most marks are won or lost.
Delivering a Diagnosis — Tell, Ask, Explain, Check
Tell: State the condition clearly and directly.
"Based on what you've told me and what we've found today, this looks like a condition called..."
Do not re-summarise symptoms at length before the diagnosis — the patient is waiting for the answer.
Ask: Find out what the patient already knows.
"Have you heard of this condition before? Do you know anything about it?"
Explain: Use plain language. Cover what it is, where the problem is, and what is going wrong.
Check: Confirm understanding actively.
"Could you tell me in your own words what you understand so far?"
Patients say 'yes' to 'Does that make sense?' regardless. Ask them to reflect back.
Plain Language Reference
| Clinical Term | Say Instead |
|---|---|
| Myocardial infarction | Heart attack |
| Hypertension | High blood pressure |
| ECG / electrocardiogram | Heart tracing |
| Oedema | Fluid build-up / swelling |
| Dyspnoea | Breathlessness / difficulty breathing |
| Biopsy | Small tissue sample to look at under a microscope |
| Malignant | Cancerous |
| Benign | Not cancerous — does not spread |
| Metastasis | Spread to another part of the body |
| Investigations | Tests |
Management Plan — Four Steps
| Step | What It Means | Example Phrasing |
|---|---|---|
| 1. Admit or not? | Decide urgency: emergency admission, urgent referral, outpatient follow-up, or reassure. | "This needs urgent hospital admission." / "I'd like to refer you to a specialist without delay." / "We can manage this safely." |
| 2. Symptom relief | What can ease symptoms now. | "We'll give you something to help with the pain / nausea in the meantime." |
| 3. Investigations | Order after history and examination — not before. Use plain language. | "We'll do a blood test and a chest X-ray to help confirm this." |
| 4. Specific treatment or referral | The targeted intervention: medication, surgery, physiotherapy, lifestyle, or specialist referral. | "We'll start a tablet called [X] which works by [plain language]." |
Always request bedside tests (ECG, urine dipstick, pregnancy test, fingerprick blood glucose) during the examination phase — say them out loud so the examiner can hand you the result.
Raising the Possibility of Cancer — 2-Week Wait Pathway
Use this structure whenever referring urgently under the 2-week wait pathway. Be honest, but not catastrophising.
"Based on what you've told me — [brief clinical reason] — one of the things I have to consider is that this could be something serious, including cancer. I want to be clear: we don't know that yet. But because of these features, I'd like to refer you urgently to a specialist. This is called the two-week wait pathway — it means you'll be seen quickly so we can investigate properly. Many people referred this way turn out not to have cancer, but I don't want to miss anything important."
Use 'could be', not 'is'. Say 'unfortunately' once to open, then shift to supportive, action-focused language.
Shared Decision-Making
Assessed in both Clinical Management and IPS domains. Presenting a plan without involving the patient fails both.
| Step | What to Do |
|---|---|
| 1. Explain the situation | Summarise what you know and what decision needs to be made — in plain language. |
| 2. Present the options | Always at least two — including watchful waiting. Name each clearly. |
| 3. Explain benefits and risks | Balanced. Not pushing one option unless it is overwhelmingly clinically superior. |
| 4. Check what matters to the patient | "Some people want to avoid medication if possible. Others want to act quickly. What matters most to you?" |
| 5. Agree a plan together | "It sounds like you'd like to try lifestyle changes first — that's very reasonable. Let's review in six weeks." |