Explaining results/diagnoses

1. WIPE (Wash hands, Introduce self, check Patient details and Explain)
   1. NB Explain usually involves asking the patient what has been going on, leading up to this point- then you may explain that you are here to discuss x, y, z…
      1. Important to try and build some rapport at this point early on
      2. Assess their prior knowledge and ideas/concerns/expectations
      3. Also ask if there is anything else they are wanting to know/discuss today- it may be that their agenda is different from yours
2. Explanation
   1. Explaining a Disease
      1. If possible, explain the normal anatomy/physiology (use of a diagram may be very helpful)
      2. Go on to explain what the disease process is and what the patient has
         1. After this, IMPORTANT to check the patient has understood and answer any questions
      3.  If you haven’t already, try and explain the causes of the disease and the problems caused by the disease
      4. Explain what can be done to manage the disease
         1. NB This may mean going on to explain procedures/treatments (see below)
      5. IMPORTANT- it may be appropriate to use the SPIKES method of explaining diagnoses which may come as bad news to a patient
      6. IMPORTANT- it is also useful to give out an INFORMATION LEAFLET or similar
   2. Explaining a procedure
      1. Good idea to explore the patients prior understanding of the condition/indication and the procedure first
         1. NB Whether or not the patient has a good knowledge of the procedure should not prevent you from explaining it all in detail (for consent purposes)
      2. Explain what the procedure is/how it is done
      3. Explain the reasons for it
      4. Explain what the patient needs to do before/during/after the procedure
      5. Explain any risks/benefits/alternatives
      6. NB IMPORTANT (as with disease) to chunk and check details/understanding and summarise at the end to make sure the patient understands the main points; answer any questions the patient may have
      7. It may be that you are also required to Gain consent from the patient
      8. IMPORTANT- try and give out an information leaflet too
   3. Explaining results
      1. Again, if possible, check the patient understanding as to the condition, reason for testing, what they think the result could be etc
      2. Explain what the test set out to do and how it works
      3. Explain normal results
      4. Explain the patient results in context (particularly if the patient has had previous test results i.e. better or worse)
         1. Good idea to check that they have understood this
      5. Explain what are the options for further tests/management
   4. Explaining a treatment
      1. Important to first check for any contraindications to treatment
         1. Ask about allergies; liver disease; kidney disease; (good idea to do a focal systemic enquiry/PMHx)
      2. Check to see how much the patient understands their condition and treatment
      3. Explain what the treatment is and how it works (a diagram may be helpful)
         1. Ask if this makes sense to the patient now before going on to the practical aspects
      4. Explain the treatment course and administration
         1. NB this may involve a detailed explanation of techniques e.g. inhalers/spacers; measuring BMs/calorie counting/dose adjusting; having blood tests regularly; when to stop/continue etc
      5. Explain the side effects- and what to do if they occur
      6. The mnemonic ATHLETICS may help (Action; Timeline; How to take; Length of treatment; Effects (good and bad); Tests; Important SE; Complications; Supplementary advice)