The Art of Explaining to Patients
Clear, patient-centred explanation is one of the highest-scoring skills in the SCA. It is tested in almost every case. A strong explanation demonstrates clinical knowledge (Domain 2), shows you understood the patient’s concerns (Domain 3), and proves you gathered the right information (Domain 1).
Principle 1: Know Your Audience
- Assess health literacy: A nurse will understand differently from a retired builder. Adjust your language.
- Check existing knowledge: “What do you already know about [condition]?”
- Read the emotional state: A terrified patient needs reassurance before information.
- Respect their experience: “You’ve been managing this for a long time — tell me what you already know.”
Principle 2: Use Simple Language and Analogies
| ✅ GOOD EXAMPLE: “Think of insulin like a key that opens the doors of your cells to let sugar in for energy. In diabetes, that key stops working properly.” |
| ✅ GOOD EXAMPLE: “Your airways are like small tubes. In asthma, the lining gets inflamed and swollen, making them narrower. The inhaler reduces that swelling.” |
| ❌ BAD EXAMPLE: “Your HbA1c is elevated at 58, indicative of a glycaemic range consistent with Type 2 diabetes mellitus.” — Technically accurate, completely unhelpful. |
Principle 3: The WHAT-WHY-HOW-NEXT Framework
WHAT: What is the condition or issue, in plain terms?
WHY: Why does it matter? What are the implications if untreated?
HOW: How are we going to manage it? Medication, lifestyle, referral?
NEXT STEPS: What happens from here? Follow-up, tests, monitoring?
| WHAT-WHY-HOW-NEXT IN ACTION | WHAT: Your blood tests show that your blood sugar levels are higher than they should be. This means you have Type 2 diabetes. | WHY: It’s important we manage this because over time, high blood sugar can affect your heart, kidneys, eyes, and nerves. But the good news is that most people live well with diabetes. | HOW: We’ll start with diet and activity changes, and I’d recommend starting metformin, which helps your body use sugar more effectively. | NEXT: I’d like to see you in about 4 weeks to check how you’re getting on, and we’ll arrange blood tests. I’ll also refer you to our diabetes education programme. |
Principle 4: Chunk-and-Check
- Give one concept
- Pause: “Does that make sense so far?”
- Respond to questions or concerns
- Move to the next concept
Principle 5: Use Evidence to Build Confidence
- “The current guidelines recommend this as the first-line treatment because it has the best evidence.”
- “Research shows that this combination is the most effective approach.”
- “This screening is recommended every 2 years for your age group, based on the latest evidence.”
Principle 6: Empower, Don’t Lecture
- Offer choices: “There are a couple of approaches — let me explain them and you can tell me what you think.”
- Validate their role: “You know your body best.”
- Offer resources: “I’ll send you a link to a reliable website.”
Principle 7: Emotional Intelligence During Explanations
- “I can see this is a lot to take in. Would you like to take a moment?”
- “I notice you look a bit worried. What’s going through your mind right now?”
| TEMPLATE: Greet → Empathise → Assess understanding → WHAT-WHY-HOW-NEXT → Chunk-and-check → Empower → Support → Close |
| ⭐ KEY POINT: Practise explaining the 10 most common GP conditions (diabetes, hypertension, asthma, COPD, depression, anxiety, eczema, UTI, back pain, raised cholesterol) using WHAT-WHY-HOW-NEXT in under 90 seconds each. |