Communication
CPSA · Communication · Information giving
Chronic disease counselling — a new diagnosis to live with
A new diagnosis of diabetes, asthma, epilepsy or hypertension is not bad news in the SPIKES sense — it is a handover of self-management. The marks are in what the patient will do differently tomorrow.
The framework
Establish the starting point
- What do they already know or believe about the condition? Correct specific misconceptions rather than lecturing generally.
- Ideas, concerns, expectations — “What worries you most about having this?”
Explain in their terms
- What the condition is, in one plain sentence with no jargon.
- What it means for them specifically — work, driving, pregnancy, sport, alcohol.
Hand over the management
- What they do: monitoring, inhaler or injection technique, when to step treatment up.
- What we do: reviews, monitoring bloods, screening for complications.
- Red flags: exactly what would make them seek help, and who to contact.
Close
- Written information and the relevant patient organisation.
- Check understanding by asking them to say the plan back.
Phrases that work
- “What do you already know about type 2 diabetes?”
- “The simplest way to think about it is that your body still makes insulin, but it does not respond to it as well as it used to.”
- “There are things I will do and things that only you can do. Let me be clear about which is which.”
- “What will you tell your partner about this when you get home?”
Pitfalls that lose marks
- Delivering a lecture on pathophysiology instead of a plan.
- Omitting the practical consequences — driving, work, pregnancy — which are what the patient actually asked about internally.
- No red flags and no safety net.
- Not checking understanding, so a misconception goes home with them.