📌 SCA Tip: Strengthening the Second Half of the Consultation

Hi  👋
A reflection from watching some  cases recently. The first half (opening, ICE, history) is often well practised. The second half is where marks are more often missed, sometimes due to timing, sometimes because it's just less practised. This matters because the Clinical Management & Medical Complexity domain is weighted more heavily than the other two.

Some thoughts:

🩺 1. If you are bringing the patient in, be specific.
Tell them what examination you want to do, why, and what it will help you work out.

💭 2. Bring ICE into the second half too. The patient's ideas, concerns and expectations should shape your management plan, safety netting, and follow up.

🗣️ 3. Think out loud. Phrases like "I'm thinking this could be X or Y, and here's why" or "A feels less likely because…" make your reasoning visible.

🤝 4. Check in with the patient. A simple "Does that make sense?" or "How does that sound to you?" keeps the consultation a two way conversation.

📋 5. Make the plan specific. Say "I'd like to do a full blood count, kidney function and thyroid tests to look for X" rather than "I'll arrange some blood tests."

📞 6. If you're arranging tests, be clear how the patient will get the results. Will you call them? Will they need to book a follow up? Closing this loop is good practice and easily missed under time pressure.

🛟 7. Safety net diagnostically. Tell them what to look out for, when to come back, and how (routine, urgent, A&E). Tailor it to the presentation. Have a read of Almond, Mant & Thompson (BJGP, 2009), Diagnostic safety netting.

❓ 8. Ask "What questions do you have?" instead of "Do you have any questions?" A small linguistic shift (a presupposition) but a powerful one. This assumes the patient will have a question, and most of the time they will share one. It invites genuine conversation and shows their questions are welcome.

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