Humanising ICE - 'ideas, concerns, and expectations'

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By guest blogger Dr Aisha Yahaya...

There was an article in the BMJ recently that was written from a patient’s perspective about their experience of being ICE’d by their GP.  On speaking to friends she discovered that they too had been subject to ICE questioning and were baffled by why their GPs would ask them what they thought might be wrong with them.  After all are we not the ones with the medical degrees?  It felt unnatural to her.

In medical school, students are taught to ask patients about their ‘Ideas, Concerns and Expectations’ and often approach it as a tick box exercise - a set of obvious questions asked in order to demonstrate empathy in OSCEs.  In some cases we see students ICE their patients and not respond to what the patient has said or ask the questions out of context, which can derail consultations.  If we reflect on our consultations with patients are we really asking them appropriate questions or even listening for the answers.  The article went on to mention that if we want patients to open up about their fears then we must be ready to deal with what is revealed.  By ignoring it or parking it aside for the next appointment we do not give the patients closure or reassurance and this may prevent them from opening up again in future.

We spoke about the article in my GP half-day training session and admitted that we actually felt that sometimes it felt uncomfortable using this line of questioning with patients. To combat this, over time we had developed other ways to explore what a patient’s worries or fears might be without seeming like we were putting them in the doctor’s seat. We also individualised the questioning and slotted the questions into consultations when appropriate such as in response to a patient that clearly looks concerned or appears to want to say something but perhaps does not have the courage to do so. We also reflected on who to ask these questions to and this involves showing real empathy. There are patients who will offer their opinion on what they think is wrong with them or what they are worried about while there are others who will be concerned but may not say so and there are patients who want to be guided by their doctor.  It is up to us to figure out which type of patient is sat in front of us and how best to help them.

A sign of a good consultation by a patient’s standards can be judged by whether they feel listened to and that the questions they asked are answered rather than following our own agenda.  So let us listen to this feedback and try not to be so icy with our history taking.

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