Lesson 1.2 — The Cue Is Your Doorway
Cues are openings into the patient’s agenda. They may be explicit words, hesitation, repetition, a change in tone, emotion, or apparently casual life information. RCGP guidance emphasises recognising and exploring cues at an appropriate time rather than ignoring them or returning to them awkwardly later.
Five Common Cue Types
- Fear cue: “My neighbour had exactly this before she was diagnosed with cancer.”
- Impact cue: “I’ve stopped going to work because of it.”
- Relationship cue: “My husband doesn’t know I’m here.”
- Emotion cue: a long pause, tears, flat tone or sudden irritation.
- Expectation cue: “I really need a scan because tablets haven’t helped.”
You do not have to chase every cue instantly. If a cue is central to safety, emotion or agenda, explore it. If you need to finish a focused clinical thread first, acknowledge it and explicitly return to it.
Case 2 — Palpitations and sudden death in the family
A patient reports three weeks of intermittent palpitations.
“My dad died suddenly when he was 46, but I’m probably just being silly.”
Ignoring the family history because the patient minimises it.
“You’re not being silly. Your dad’s death sounds as though it has made these palpitations particularly worrying. Can you tell me a little more about what happened to him?”
The response validates the concern without making a diagnosis, and it also opens clinically relevant information.