ICE is not a tick-box exercise. Formulaic ICE is one of the most common reasons candidates score poorly. The RCGP toolkit explicitly warns against asking about ICE in a “mechanistic way.” Think of ICE as Thoughts, Worries, and Help.
Bad ICE (Avoid These)
- “Do you have any ideas about what’s going on?” (robotic)
- “Are you concerned about anything?” (too vague)
- “What were you expecting today?” (sounds like a customer service survey)
Good ICE (Use These Instead)
- “What do you think might be causing this?”
- “Is there anything in particular that’s been worrying you about this?”
- “What were you hoping we could do about this today?”
The ICE Phrase Bank — Ready-to-Use Language:
Ideas (Thoughts): What Do They Think Is Going On?
- “You’ve had this for a few weeks — have you had any thoughts about what might be causing it?”
- “Have you done any searching online about your symptoms? What did you find?”
- “What do you think is the most likely reason you’ve been feeling this way?”
- “Has anyone else — a friend, family member — suggested what it might be?”
Concerns (Worries): What Are They Afraid Of?
- “What’s worrying you most about these symptoms?”
- “What’s the worst thing you feel could be causing this?”
- “You look troubled — may I ask what’s on your mind?”
When the patient won’t say:
- “Many people with these symptoms are often worried about [cancer/heart disease]. Does the same apply to you?” — normalises the fear
- “If your partner were here, what do you think they’d be most concerned about?”
Expectations (Help): What Do They Want From Today?
- “Was there anything you were hoping I could do for you today?”
- “When you booked this appointment, what were you hoping to get out of it?”
- “What would I need to do today for you to leave here feeling reassured?”
When they deflect (“You’re the doctor”): Try a more direct angle: “Was there a particular treatment you were hoping for?” or “Were you hoping to see a specialist?”
| ⭐ KEY POINT: The mark is not for asking ICE. The mark is for the patient feeling genuinely understood. If you explored their thoughts, worries, and hopes naturally through cue-following and empathetic questioning, you have achieved ICE — even if you never used those words. |
| ⚠ COMMON PITFALL: If you ask ICE as three rapid-fire questions at the end of data gathering, it will feel forced. Instead, weave ICE throughout the consultation, responding to cues and following the patient’s lead. |