History take: ideas, concerns and expectations
Welcome to my blog page, thank you for taking the time to read this, I hope you are all well during these odd times.
“Ideas, concerns and expectations” commonly referred to as "‘ICE’ can be questions that make you feel uncomfortable. It can feel like it stops the flow, feels out of place and repetitive.
This blog will outline WHY it is important and HOW to integrate it into your history, so it flows better. As without the KNOW- it’s difficult to truly remember to the ask the questions with conviction.
The example questions are just examples, you should find what is comfortable for you!
IDEAS
“What do you think is going on?”
“What are your ideas on what might be causing these symptoms?”
Why are we asking this?
Essentially you want to know what is on the patients mind. You want them to say what they think might be going on, which could be completely irrelevant. Getting their prospective on what they think the cause of their symptoms are, will introduce a starting point for when you are telling them what YOU think their diagnosis is.
Putting it into context:
“Mrs Smith, you suggested you thought you may have asthma, well taking your shortness of breath and noisy breathing into account, this does seem very likely”
CONCERNS:
“Was there anything you were particularly worried about?”
“You did say you were worried about cancer, do you have any other worries?”
Why are we asking this?
We want to know what worries the patient the most, which might NOT always be their “ideas”! They might think they have asthma (ideas), but worried it could be lung cancer (concerns). Patients/actors are complex, they have many worries and anxieties, which they don’t always discuss, so it is our job as doctors to bring this out.
Putting it into context:
“Sheila, you said you were worried you might have cancer like your brother, tell me more about this”
EXPECTATIONS:
“What were you hoping for from todays consultation?”
“How can I best help you today?”
Why are we asking this?
You want to get an idea of what the patient wants from today, do they want a blood test? Do they want you to reassure them, the list is endless. Knowing the “expectations” can be nicely linked to the diagnosis/management of the patient. Again, we feel this is an odd question- they are worried about cancer and they OBVIOUSLY want me to rule this out? This is not always the case.
Putting it into context:
“George, you said that you would like a chest X-ray for this persistent cough, well I agree that would be a good next step”
I hope you found the information useful and easy to follow. I do believe that practice makes perfect, so whether that is practicing with friends or signing up for one-to-one revision with myself- keep focused :)
Remember this exam is like a driving test- everything has to be obvious and exaggerated for the marks. Make the examiner’s life easy and SHOW them the marks!
Happy revision :)