Medical Explanations
Because patients deserve more than medical jargon — and so do you. The art of explaining things clearly is one of the most powerful clinical skills you'll ever develop.
📥 Downloads
Handouts, summaries, and teaching extras — ready when you are.
path: EXPLANATIONS
- 5 things all patients want to KNOW.ppt
- communicating a management plan.doc
- easy peasy medical drawings.pdf
- explaining medical conditions.ppt
- explaining risks - turning numerical data into meaningful pictures.pdf
- explaining uncertainty - when you don't know.ppt
- explanation - what patients want to know.ppt
- explanations - how much to tell the patient.doc
- explanations - scenarios (TEACHING RESOURCE).doc
- explaning and planning skills.doc
- language matters - switch small things you say - for example in diabetes.pdf
- medical explanations score card (TEACHING RESOURCE).doc
- nocebo effect - example with statins and antidepressants.docx
- premature reassurance.doc
- spend a penny and other things patients say - by jill choudhury.pdf
🌐 Web Resources
A hand-picked mix of official guidance and real-world GP training resources. Because sometimes the best pearls are not hiding in the official documents.
🏥 Core GP Training Resources
📋 SCA & Consultation Skills
🩺 Patient Information & Health Literacy
⚡ Quick Summary — If You Only Read One Thing
- Explanations in GP go way beyond just "what is the diagnosis" — you explain findings, investigations, anatomy, treatments, referrals, and more.
- Start from where the patient already is — use their own words and understanding as your springboard. Never give a generic explanation when you have ICE data to work with.
- Keep it simple. Avoid jargon. Chunk information into pieces. Check understanding as you go — not just at the end.
- Signpost each transition in the consultation: tell the patient what you're about to explain before you explain it.
- Use analogies wherever you can — they are the fastest way to help patients grasp concepts they've never encountered before.
- Teach-back is the gold standard for checking understanding — ask the patient to explain it back to you in their own words.
- Drawings are under-used and surprisingly powerful — you don't need to be Michelangelo. A rough sketch often beats a thousand words.
- In the SCA, the explanation domain assesses how clearly you help the patient understand — and how you weave in their concerns and ideas.
- Premature reassurance is one of the biggest explanation traps — don't say "it's nothing to worry about" before you know what they're worried about.
- A good explanation that the patient understands is worth more to their health outcomes than any prescription you write.
Why This Matters in GP
Explanation isn't a soft skill bolted onto the end of the "real" consultation. It is clinical care. A patient who doesn't understand their diagnosis won't engage with treatment. A patient who doesn't understand their medication won't take it.
When done well, explanation improves adherence, concordance, patient safety, and patient satisfaction — and it reduces avoidable re-attendances. When done badly, it erodes trust, increases anxiety, and leaves the patient worse off than when they arrived.
And in the SCA, the explanation domain is specifically assessed. Not just what you say, but how you say it, whether you check it landed, and how well you wove in the patient's own concerns.
A patient wasn't taking his post-MI medication — five drugs, all stopped. The regular doctor had shrugged: "We've done our bit. His choice."
"But why do all that hard work and put this patient on all that medication if he's not going to take it? And surely the fact he isn't taking it is an indication that his thinking is different from ours — and we need to explore that."
So the patient was brought back. He was asked, simply, what he understood about heart attacks. It turned out: he knew what they were, but he never thought they were that serious. He had friends who'd had heart attacks and were "all doing fine." He thought the streptokinase had done its job and that was that.
A 10-minute conversation later, he understood why people are put on these medications after an MI, and he was shocked to hear about the risks of another heart attack or heart failure. He hadn't taken the tablets because he thought doctors were being over-cautious — not because he was being difficult.
"He was so grateful for me taking time to explain things to him. And boy did I feel good."
In summary: explain things in a way that makes sense to them — starting from where they are, not where you are.
The 6 Types of Explanations We Do
Think explanations are just about the diagnosis? Think again. In a single consultation, you might need to explain six different things — and each one has its own challenges.
Core Explanation Skills
Simple doesn't mean dumbed-down. It means not forcing the patient to do cognitive work they don't need to do.
- Signpost first — before you start explaining, tell the patient you're about to explain something: "Let me take a moment to explain what Diabetes actually is."
- Invite questions from the start — "Before I go on, please do interrupt me if anything I say doesn't make sense — it happens more than you'd think."
- Avoid jargon — if you must use a medical term, break it down immediately. Don't wait and see if they ask.
- Only explain to the appropriate level — not the level you'd use with a fellow doctor.
- Keep it concise — endless explanations lose patients. Say what needs to be said, then stop.
- Watch non-verbals — a patient nodding politely is not the same as a patient understanding. If they look lost, slow down and explore. Don't just race to the finish line.
The Asthma Test — Simple vs Over-Complicated
"Your lungs are made up of loads of tubes. These tubes allow air in and out. But in asthma, these tubes become tight and too narrow, which means air can't get in as freely — and so you have difficulty breathing and often wheeze."
"Your lungs are made up of two main bronchi which split into bronchioli and end in alveoli where oxygen transfers into the blood... but in asthma these bronchi and bronchioli are too tight and inelastic and so air becomes trapped and cannot flow so easily hence the patient struggles with breathing and has a wheeze."
The second explanation isn't wrong — it's just unnecessarily complex for the average patient. Save the full anatomical detail for the medical school lecture hall.
The 7 Keys to a Simple Explanation
When you have a lot to explain, do it in manageable pieces. Explain one chunk, check understanding, then move to the next. This technique is backed by strong evidence on health literacy and patient recall.
🟦 CHUNK
Explain one piece of information clearly. Keep it brief. Use plain language.
✅ CHECK
Pause and check understanding before moving on. Use teach-back (see below).
🟦 CHUNK
Move to the next piece of information — but only once you're sure the first landed.
How to Check Understanding (Teach-Back)
Teach-back is the gold standard. You ask the patient to explain things back to you in their own words — not to test them, but to check that you explained it well.
- ❌ Don't ask: "Do you understand?" — patients will nearly always say yes, even if they don't. Nobody wants to look stupid.
- ✅ Do say: "Can I check whether I've explained things clearly? What have you taken from what I've said so far?"
- ✅ Or: "Sometimes I use complicated words out of habit and it makes things confusing. Is there anything you'd like me to go over again?"
- ✅ Or: "We've covered quite a bit there — would you be able to explain to me what you're going to do when you get home?"
The most common explanation mistake is giving a generic explanation — as if every patient with asthma is the same blank page. They're not. By the time you reach the explanation phase, you should already know:
- Ideas — what the patient thinks is going on
- Concerns — what they're worried or fearful about
- Expectations — what they were hoping you would do
Use this as your springboard. Weave it into the explanation. This is patient-centred care in action — and it makes the SCA examiner sit up and pay attention.
Asthma — Same Condition, Two Very Different Explanations
The setup: Mrs X's son may have asthma. She has a niece hospitalised with asthma. She's worried, and she already knows that "lung tubes become tight and narrow" and that people carry inhalers.
"Your lungs are made up of loads of tubes and these become tight and too narrow in asthma, which means air can't get in freely and there's a wheeze. The good news is inhalers open those tubes back up. Asthma can be serious and even fatal — that's why people carry inhalers at all times. Now, about these inhalers..."
"Yes Mrs X, you're right — those tubes do become narrow and tight, and yes, we do give inhalers to open them back up. And like you've figured out with your niece — asthma isn't something to take lightly. It can suddenly flare and be very serious, very quickly. That's exactly why we say to keep inhalers at all times, even when feeling well. Now, about these inhalers..."
The added benefit: when every explanation is grounded in ICE, no two explanations of "asthma" are ever quite the same. And that matters more than you might think — not just for the patient, but for you. Each consultation becomes its own individual conversation, full of dynamism and energy, rather than a dry script you've recited a hundred times before. Patient-centred explanation doesn't just improve outcomes — it keeps the job interesting.
- Same script every time
- Explains things the patient already knows
- Misses the specific fear
- Feels longer than it needs to be
- Forgettable — patient switches off
springboard
- Different every time — never boring
- Starts from what they already know
- Directly addresses their specific fear
- Shorter — no need to explain what they know
- Memorable — it's about them, not a textbook
Analogies are central to human cognition. We build new understanding by connecting it to something we already know — we think in pictures and comparisons, not definitions. That's why a well-chosen analogy can do in 10 seconds what a 5-minute explanation struggles to achieve. Using analogies is genuinely a win-win: they make your job easier and they make the patient's understanding better.
- They help patients visualise what's happening inside their body
- They reduce anxiety by making the unfamiliar feel familiar
- They are memorable — patients carry them home and share them with their family
- They make your job easier — once you've found a good analogy, you'll use it forever
Leaflets are a legitimate and valuable tool — but only when used thoughtfully. Handing over a leaflet without context is the equivalent of saying "here, go read this" and hoping for the best.
- Introduce the leaflet — briefly explain what's in it and why you're giving it: "This leaflet covers exactly what we discussed about your blood pressure — and it's got some good tips on the lifestyle side too. Worth a read when you get home."
- Read leaflets yourself before handing them out — if you've never read the asthma leaflet from patient.info, you genuinely don't know what you're giving patients. Reading them is also great for improving your own explanations.
- Don't offer leaflets reflexively — in the SCA, "I'll print off a leaflet for you" offered for every condition looks rehearsed and hollow. Use it where it genuinely adds value.
- Good sources: patient.info and NHS.uk are the gold standards for plain English, accurate, UK-appropriate leaflets.
Drawing is one of the most under-used explanation tools in GP. A quick sketch can convey spatial and structural concepts in seconds — and patients remember drawings far longer than words.
- You don't have to be good at drawing — and that's not false modesty, it's genuinely true. A drawing doesn't need to be an accurate anatomical representation; it just needs to be clear enough to illustrate the concept. A rough sketch of two tubes narrowing to explain asthma is worth more than a perfectly labelled diagram of the bronchial tree that takes you three minutes to draw.
- Draw big — use the whole sheet of A4. A thumbnail sketch in the corner of a page is nearly useless. You have the space — fill it.
- Ask yourself: "Would a drawing actually help here?" — this is the key question. Not every explanation needs one. Simple concepts often don't. For example, to explain trochanteric bursitis you might simply say: "There's a small gel-like cushion that protects the outer part of your hip bone. It looks like that has become inflamed and swollen — that's what's causing the pain there." A diagram wouldn't add much. But to explain how a slipped disc presses on a nerve? Absolutely draw that.
- In face-to-face consultations: drawing is ideal for spine problems, heart anatomy, skin conditions, joint problems, and anything structural or spatial.
- In remote/telephone consultations: use verbal analogies and direct patients to trusted resources like NHS.uk or patient.info instead.
Should I Draw This?
e.g. how a disc presses on a nerve, how a heart valve leaks
A signpost tells the patient where you're going before you get there. It adds structure to your explanation and prevents the consultation from deteriorating into an unnavigable muddle.
Think of it this way: if someone gave you driving directions without warning you about each turning, you'd miss half of them. Signposting is the "turn right in 200 metres" of the consultation.
Examples of Signposting in Action
- "Mrs X, is it okay if I explain a bit more about asthma?"
- "So, let's now move onto the inhalers and talk about those more specifically."
- "Now, let's talk about what happens in a severe asthma attack and what you should do."
- "I know there's been a lot of information there. Let's just take a moment to summarise things so we're both on the same page."
The Holiday Story — Signposting Makes Everything Clearer
Here's an illustration. Read version A and B, and notice how much easier B is to follow.
So, yeah, I went to New York for 2 weeks. And the flights were worth it. Cost an arm and a leg. I saw the Statue of Liberty which isn't that big. And I went to see that island nearby. The weather was on our side. On the third day we went to see the Rockefeller building. And we had burgers that day. We went to Grand Central on the 5th day. It's one of the best stations I've ever seen. And in the evening we ate out a lot. And then we came home…
So yeah, I went to New York for 2 weeks. The flights were worth it — cost an arm and a leg but worth it. Let me tell you what we got up to. We saw the Statue of Liberty, Rockefeller, Empire State, and Grand Central Station — one of the best stations I've ever seen. And the food? Burgers aren't as big as I expected, but the restaurants were amazing. And throughout the whole trip, the weather was brilliant.
There is no one "right" consultation framework — the best one is the one you make your own. But here is a reliable step-by-step structure that works for most explanations in GP.
1. Signpost — tell them you're about to explain
"Let me take a moment to explain what's going on..."
2. Invite questions — make it safe to ask
"Please interrupt me if anything I say doesn't make sense."
3. Start from their starting point — use their ICE
Weave in what they told you about their ideas, concerns, and expectations.
4. Chunk — explain one piece at a time
Keep each piece simple. Use plain language. Use analogies. Draw if helpful.
5. Check — teach-back after each chunk
"Can I check you've got that before I move on?"
6. Signpost again — move to the next section
"So, let's now move on to talking about the treatment options..."
7. Summarise — close the explanation loop
"Let's just take a moment to recap the main points before you go."
📚 Books to Take This Further
Common Pitfalls
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Premature reassurance Saying "don't worry, it's nothing serious" before you've asked what the patient is actually worried about. This is patronising at best and clinically dangerous at worst — what if it is serious?
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The monologue explanation Launching into a 3-minute uninterrupted explanation without checking in or inviting questions. The patient switches off at around minute one. No check-in means no feedback loop.
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Jargon creep Starting clearly and then drifting into "the TSH is suppressed and free T4 is elevated, which is consistent with thyrotoxicosis." Translate results into plain language every time. This takes practice but quickly becomes automatic.
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Ignoring ICE data you already gathered You spent 4 minutes discovering the patient thinks they have cancer. Then you give a completely generic explanation of their haematuria without acknowledging that fear. This loses marks and misses the point of patient-centred care.
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Vague safety-netting "Come back if you're worried" gives the patient nothing to act on. Name specific symptoms, timeframes, and next steps. What exactly should they come back for? When? What should they do right now?
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Explaining before listening Starting the explanation before you've fully understood the patient's ideas, concerns, and expectations. You end up giving an explanation that talks past their actual worry — which is exhausting for everyone.
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Offering a leaflet as a substitute for explanation Handing over a leaflet without discussing it is not an explanation. It's a deferral. Use leaflets as a supplement to — not a replacement for — a real conversation.
For Trainers
🔍 Common Learner Blind Spots
- Not using ICE data already gathered — transitions to generic explanation despite patient-specific information being available
- Checking understanding with "Does that make sense?" — comfort question, not real check
- Forgetting signposting when concentrating on clinical content
- Analogies feel risky or unscientific — trainees undersell their value
- Premature reassurance when the trainee is uncomfortable with patient distress
💬 Tutorial Discussion Prompts
- "Tell me about a recent explanation that didn't quite land — what happened and why?"
- "Walk me through how you'd explain [hypertension / Type 2 diabetes / AF] to a worried 60-year-old with no medical background."
- "How would your explanation change if the patient had already told you they thought they had cancer?"
- "Show me how you'd use teach-back for this case."
📊 Ways to Assess Explanation Skills
- Review COT / audioCOT footage specifically looking at explanation phase
- Role-play — you play the patient; ask them to explain a recent diagnosis they gave in clinic
- Ask the trainee to explain a condition using only an analogy — no jargon at all
- Use the Medical Explanations Scorecard from the downloads section above
🎭 Tutorial Scenario Ideas
- "A patient with AF who says they've been told their heart is doing something weird — explain what AF is, why it matters, and what happens next."
- "A patient newly diagnosed with Type 2 diabetes who is convinced it's because they ate too many sweets as a child."
- "A patient who has just had a normal colonoscopy and is confused about why — if everything was normal — they need a repeat in three years."
- "A patient who refuses to take statins because they 'heard they destroy your liver.'"
Quick Questions
The 6:6 Rule — How to Split Your Time
Repeatedly cited by passed candidates and SCA examiners as the single most practical structural tip for the SCA. Getting this wrong is the most common reason consultations fall apart — not lack of knowledge.
- Most candidates who fail do so because they spend 9–10 minutes gathering history and have 2–3 minutes left — not nearly enough to explain, share a management plan, and safety-net properly.
- Practise with a visible countdown timer from day one of revision. The SCA counts down from 12 minutes. Get used to the psychological pressure of seeing the clock.
- Target finishing most consultations within 10 minutes — leaving 2 minutes to re-engage, summarise key points, and close unhurriedly. That spare 2 minutes is where rapport and "Relating to Others" marks get collected.
The 8-Point Consultation Scaffold
A consultation structure used and recommended by passed SCA candidates. Write it on your whiteboard before the exam starts so it's in your peripheral vision throughout. It's not a rigid script — it's a safety net for when anxiety makes your mind go blank.
Going Beyond ICE — The IMP Upgrade
ICE is the foundation — but seasoned UK GP educators and trainers note that many candidates gather ICE and then fail to use it meaningfully. The IMP framework (developed by GP Fluency, a UK-based GP training platform) helps you translate what you've heard into a truly tailored explanation and plan.
ICE tells you what the patient thinks. IMP tells you what the patient needs. A patient with a new diabetes diagnosis might share their ICE — "I think it's because of my diet; I'm worried about going blind; I want medication." But IMP reveals that the diabetes means they might not be able to drive for work, that "diabetic" feels like a shameful label in their family culture, and that their priority is avoiding injections at all costs. That's the explanation and plan the patient actually needs. ICE alone wouldn't have got you there.
Explaining Results — The Before/After Test
A recurring theme from UK GP training educators: candidates in results-based consultations fall back on numbers and jargon because they feel more "clinical." But numbers mean nothing to most patients. The transformation below is specifically what scores well in the SCA — and what actually helps patients in real life.
Things Nobody Tells You (At First)
Distilled from passed candidate accounts, deanery guidance pages, and GP training educator communities across the UK.
Every time you hear a phrase in clinic or a tutorial that lands well — a colleague's turn of phrase, a trainer's way of explaining something, a phrase from a video — write it down. Aim to try one new phrase in every other consultation. Don't try to change everything at once; it causes you to lose your natural voice. One new phrase at a time, practised until it's yours, is how real improvement works.
Most trainees avoid this. The ones who pass tend to do it. Recording your consultations (with patient consent, using your practice's usual process) and watching them back — especially the explanation phase — reveals habits you had no idea you had. Are you making eye contact when you explain? Are you rushing? Do you check understanding? Do you drift into jargon? The camera sees what your trainer sees. It's uncomfortable. Do it anyway.
A common habit from hospital medicine: gather all the information, disappear mentally for 30 seconds to formulate a plan, then deliver it in one go. In GP — and especially in the SCA — this loses marks. The examiner wants to see a flowing, two-way conversation throughout. Verbalise your thinking as you go. "I'm wondering about a couple of possibilities here — let me explain what I'm thinking." The patient feels involved. The examiner sees a collaborator, not a lecturer.
A well-known examiner feedback point: candidates often ask about smoking, alcohol, and past medical history as a reflex — for every single case, regardless of relevance. Examiners notice. In a 12-minute consultation, asking about a patient's smoking history when they've come about a relationship problem wastes time and signals autopilot. Only ask when it's clinically relevant — and know why you're asking.
In the SCA, the only thing you can write on is your whiteboard. Use it during data gathering to jot key points without looking away from the patient — this keeps you engaged while helping you remember what was said. When you reach the explanation phase, referencing back to what you wrote ("You mentioned earlier that you were worried about your heart — let me come back to that now") makes the patient feel heard and signals to the examiner that you were listening throughout.
The 3 minutes of reading time before each SCA case is precious — and easy to waste. The tip from passed candidates: spend 2 minutes reading the case thoroughly, then 1 minute structuring your opening and thinking about likely ICE issues. For cases involving investigations or results, consider checking the BNF treatment summary during reading time — it's the only resource you can use. Knowing you've checked it gives you confidence to explain treatment options clearly without hesitation.
In your study groups, make one person play a difficult patient — not hostile, but testing: the one who doesn't volunteer information, the one who keeps asking "but why?", the one who looks upset but says they're fine. The SCA role-players are trained to create these moments specifically. Candidates who only practise with cooperative patients often freeze when the role-player doesn't play along with the expected script. "Be awkward" in practice sessions is genuinely useful advice.
After a case that didn't go as planned, there's a strong temptation to carry the anxiety into the next one. A technique repeatedly cited by passed candidates: deliberately reset between cases. Say to yourself — out loud if needed — "I have been good at consulting. I am good at consulting. I will be good at consulting." This is not just feel-good advice. There is evidence that deliberate positive self-talk genuinely improves performance under pressure. The SCA has 12 cases. One imperfect case does not determine the outcome.
The Explanation Quality Spectrum
Based on what UK GP training educators describe as the key differences between fail, pass, and clear pass in the explanation domain. Where do you currently sit?
- Generic explanation — no reference to ICE
- Jargon heavy — patient cannot follow
- No checking of understanding
- Vague or absent safety-netting
- Patient passive recipient of information
- Uses patient's ICE to frame explanation
- Plain language — mostly jargon-free
- Checks understanding at least once
- Specific safety-netting with timeframe
- Shared decision-making attempted
- Explanation woven from patient's exact words and concerns
- Analogy or visual used instinctively
- Chunk-and-check throughout — not just at the end
- Safety-netting names specific symptoms and escalation route
- Management plan co-created with patient, reflecting their priorities
How to Practise Explanation Skills Deliberately
Rotate: one plays the patient, one plays the GP, one acts as observer/examiner. The observer specifically watches the explanation phase — does it use ICE? Is there chunk-and-check? Does the patient understand the plan? Groups of 3–5 are cited by passed candidates as the optimal size — large enough for diverse feedback, small enough that everyone gets involved in every case.
The SCA is a remote exam. Practising over Teams or Zoom from early on prepares you for the specific challenges: maintaining eye contact with the camera rather than your own face, ensuring your explanation is clear without physical gestures, managing the slight awkwardness of explaining something remotely. Trainees who only practise face-to-face can find the remote format harder than expected.
A technique recommended by GP training educators: for common conditions (Type 2 diabetes, hypertension, asthma, CKD, GORD, hypothyroidism), practise explaining what the condition is in no more than two sentences using plain language and no jargon. Then add one sentence connecting it to this specific patient's concern. Do this for 20 conditions and your explanation fluency will transform. Write them out; say them aloud; refine them until they feel natural.
Reading NICE CKS summaries for common conditions is not just revision for the clinical knowledge component — it also helps you understand the natural language of explanation. The patient information sections within NICE CKS are written in accessible plain English, and reading them trains your brain in how to describe conditions without jargon. Multiple passed candidates mention this specifically as a source of explanation language.
🎯 SCA — What Examiners Are Actually Looking For
The SCA doesn't just test whether you know the diagnosis. It tests whether you can communicate it to a human being in a way that's clear, honest, patient-centred, and actually useful. Your explanation domain score depends on this.
- You use the patient's own words and concerns in your explanation — not a generic textbook version
- You signpost clearly: the patient (and examiner) always knows where the consultation is going
- You chunk information and check understanding actively — not just "does that make sense?" at the end
- You acknowledge uncertainty honestly without losing the patient's confidence
- You offer a clear working diagnosis with a brief reason: "From what you've told me and what I've found, I think this is most likely X — because of Y and Z."
- You involve the patient in the management plan — shared decision-making, not prescription delivery
- You safety-net specifically and explicitly — not a generic "come back if worried"
- Giving a lecture, not an explanation — reading out NICE guidance at the patient scores nothing in "Relating to Others"
- Giving a generic explanation — ignoring ICE data you gathered earlier is a missed opportunity that examiners notice
- Premature reassurance — saying "it's nothing to worry about" before you've fully explored what they're worried about
- Not checking understanding — launching straight from explanation into management without pausing to check
- Vague safety-netting — "come back if you're concerned" is not enough. Specify what to look out for and when to act.
- Skipping explanation under time pressure — trainees who run low on time often drop the explanation entirely. This loses marks across multiple domains.
- Using jargon mid-explanation — especially for results. "Your TSH is elevated" means nothing to most patients. Translate it.
- When you give a diagnosis, add a brief reasoning statement: "I think this is most likely X — because you've had it for three weeks, it's worse in the morning, and there's no red flag features."
- Name the patient's worry before reassuring: "You mentioned you were worried it might be something serious — let me address that."
- When discussing options, always explicitly ask what the patient thinks: "What are your thoughts on that?"
- Use the patient's name during the explanation — it signals genuine engagement, not a scripted delivery
- When uncertain, say so clearly rather than bluffing: "I want to be straight with you — I'm not completely certain yet, and here's what I'd like to do to find out." Honesty is a scoring behaviour.
🗣 Consultation Phrases That Actually Work
These phrases are designed to sound human, not scripted. Read them once and then adapt them — don't repeat them verbatim or they'll sound rehearsed. The goal is to internalise the structure, not memorise the words.
Starting the Explanation
- "Let me explain what I think is going on here."
- "Can I take a moment to talk through what this means?"
- "Before we talk about what to do next, let me explain what I found."
Giving a Diagnosis (with Reasoning)
- "From what you've told me and what I've found, I think this is most likely [X]." Then add the reason: "…because of Y and Z" — this is what separates a clear explanation from a bald statement.
- "Everything points towards [X] — the main reason I say that is [Y]."
- "The good news is, I don't think this is anything sinister. I think what's happening is..."Use when you've already heard a specific worry — and only after you've explored it, not before.
Example in Context: Explaining High Blood Pressure
Explaining What's Happening in the Body
- "Think of it a bit like [analogy]..."
- "The way I'd describe it is..."
- "I find it helps to think of [organ/system] as [everyday object]."
Example in Context: Explaining Type 2 Diabetes
Handling Uncertainty Honestly
One of the most underrated SCA skills. Examiners are not expecting you to know everything. They are expecting you to be honest when you don't — and to manage that uncertainty safely.
- "I want to be honest with you — I'm not completely certain at this stage, and here's why." Then explain your thinking: what you know, what you don't, and what you'd like to do next.
- "There are a couple of possibilities here. Let me explain them both and then we can decide together."
- "I think this is most likely X, but I can't be completely certain without [test/time/specialist review]."
- "Sometimes in medicine, we can't give a definitive answer straight away — and I'd rather be honest with you about that than give you false certainty."
Saying "I don't know, but here's how I'm going to find out" scores better than a confidently wrong diagnosis. The SCA rewards intellectual honesty — don't try to bluff your way through uncertainty.
Explaining the Management Plan
- "So the plan I'd suggest is this — and I want to make sure this works for you too."
- "We've got a couple of options here. Let me talk you through them."
- "I'd recommend we try [X] first — the reason I suggest that is [Y]." Always give a reason for your recommendation. "Because the evidence supports it" is better than nothing; "because it tends to work well for this type of problem and has a good side-effect profile" is even better.
Shared Decision-Making — Making It Feel Real, Not Formulaic
Shared decision-making is a scoring domain in the SCA. But it has to feel genuine — not like you're running through a checklist. These phrases help:
- "What are your thoughts on that?"
- "Is there anything about that option that worries you?"
- "What matters most to you in how we manage this?"
- "Would you be happy to give that a try, or would you rather think about it first?"
Checking Understanding (Teach-Back Phrases)
- "Can I check I've explained that clearly — what's your understanding of what we've just talked about?" Frames it as checking your explanation, not their intelligence. Far less threatening.
- "Just to make sure I haven't over-complicated this — what's the main thing you're taking away from today?"
- "Before you go, can you tell me in your own words what you're going to do and what to look out for?"
Safety-Netting — Be Specific, Not Vague
Vague safety-netting is a very common SCA failure. "Come back if you're worried" says nothing. Good safety-netting tells the patient what to look out for, when to act, and where to go.
- "If things haven't improved in [specific time frame], I'd like you to come back." Name the timeframe. "A few days" is much better than "if you're concerned."
- "If you notice [X, Y, or Z], please don't wait — come in or call 111 straight away." Name specific symptoms. Don't leave the patient guessing what "worse" means.
- "The things that would change my thinking on this are [specific features] — and if those develop, we'd need to act more urgently."
Example: Safety-Netting a Chest Infection in GP
Closing the Consultation
- "Is there anything else you wanted to talk about today?"
- "Are you happy with the plan we've agreed?"
- "I want to make sure you leave today feeling clear about what's happening and what to do."
- "We've covered quite a lot today. Let me just summarise the key points before you go."
Trainees most often run out of time because they spend too long gathering history and have almost no time left for management and explanation. Target roughly 6 minutes of history gathering and 6 minutes of explanation and management. If time is short: signpost clearly, state your working diagnosis, give one management option, and safety-net specifically. A partial but well-structured consultation scores better than a panicked one that tries to cover everything badly.
🏁 Final Take-Home Points
- Explanation is not a soft skill bolted onto the end — it is core clinical care, and poor explanation actively harms patients.
- Always start from the patient's ICE data. A generic explanation is almost never the best one.
- Signpost every transition. Tell the patient where you're going before you get there.
- Chunk and check — never give a monologue. Pause, check understanding, then continue.
- Teach-back is the gold standard. "Does that make sense?" is not good enough — ask patients to explain it back in their own words.
- Analogies are powerful and under-used. A good analogy does in 10 seconds what a 5-minute explanation struggles to achieve.
- In the SCA, the explanation domain runs through the whole consultation — not just when you give the diagnosis. Signposting, checking understanding, and honest handling of uncertainty all score marks.
- Vague safety-netting is a fail waiting to happen. Specific timeframes and specific symptoms — every time.
Keep explanations SIMPLE
Keep things simple.
- Signpost when you are going to do an explanation (more on signposting below).
“Let me take a moment to explain what Diabetes actually is” - Be clear that it’s okay for them to ask you to clarify anything
“Before I go onto the explanation, please do interrupt me if there is anything I say that doesn’t make sense or is confusing.”
Be upfront with them and that it’s ok for them to ask for clarification, especially for complex conditions to explain like Diabetes. Let them know how important it is for their future health that they understand the diagnosis, its rationale and plan. Also let them know that sometime you can use unfamiliar words and concepts out of habit and if they’re not sure, please ask. - Simple jargon-free words – keep it free of lots of fancy medical words. If you have to use jargon – break it down and explain.
Using leaflets to help you explain things to patients is good practice.
- The problem is that candidates doing the CSA exam often offer leaflets as a generic thing. CSA examiners really don’t like it when you say “And i’ll print off a leaflet about asthma for you” because you can blindly say that for any condition and it looks rehearsed like as if you’re only paying lip-service rather than anything meaningful.
- If you are going to offer a leaflet, please try and talk a bit about the leaflet and what it contains – to introduce it it to the patient and brief them about it – just like real GPs do in real consultations. You should have a rough idea of what is in a condition leaflet for the major conditions. If you don’t – it shows that you DO NOT OFTEN give patients leaflets in your consultations – so why do it just for the CSA exam?
- In fact, if you are not giving leaflets to patients often in your GP consultations, please start doing so now. And start reading them before you hand them out. Reading leaflets can offer you ways of explaining something better than what you already have in your mind. Leaflets also help you understand what are the major things of a medical condition worth discussing. Good leaflets can be found here: www.patient.co.uk and www.nhschoices.co.uk .
Draw things if it will make things easier
- Again, drawing something to help a patient understand something is generally a good thing.
- You don’t have to be good at drawing. Remember, it is to give the patient a good enough idea – so keep drawings simple. A drawing doesn’t have to be an accurate representation of the real thing – it just needs to be able to illustrate your concepts (see picture left). In real life, if you can’t draw, then search for an image from Google images and use that (unfortunately, you cannot do that in the CSA).
- Draw big. Don’t do a thumbnail drawing of a set of lungs (for example). You have a whole sheet of A4 – so use it! Little piddly wonky diagrams drawn in the corner of an A4 page are next to useless.
- Remember that not all explanations require a drawing – simple concepts don’t. Ask yourself the question ‘Would a drawing help here?’. You don’t have to draw all the time. For example, I personally wouldn’t draw a hip to explain trochanteric bursitis. It’s easier just to say ‘there is a small gel-like cushion that protects the outer part of your hip bone. It looks like that has become inflammed and all swollen and that is why it’s so painful there.’. Isn’t that much easier? A diagram (I don’t think) would add a great amount of additional meaning and understanding.
- The image below is free to download. See the ‘easy-peasy medical drawings’ document in the downloads section above.