AIM: To develop skills in noticing and responding to patient cues.

INTRODUCTION: Sometimes patients are reluctant to reveal certain information for fear of embarrassment, but they may give cues or hints to let the doctor know there’s something there if they want to investigate it. It can be challenging for doctors to identify such cues, and to know how to respond to them. Cues may be given through body language (e.g. blushing, averting eyes), avoiding questions, or giving verbal hints of additional information.

In this video, the patient mentioned that her regular sexual partner was away, suggesting that any sexually transmitted infection must have a different origin. This then becomes an issue of diagnostic reasoning, and therefore is important to pursue. Recent Australian research into how international medical graduates handled this same situation revealed that those who correctly identified the alternate partner followed the following steps:

Probe – ask additional questions to further investigate a particular concern

Reassure – remind patient that the consultation is confidential, so they can openly share without fear of someone else finding out

Justify – explain why certain questions are relevant to the consultation

Acknowledge – indicate that you’ve understood what they’ve said and support them if the information given is particularly sensitive

INSTRUCTIONS: For each statement below, identify which of the functions it matches.

Please answer every question before continuing.

FOLLOW-UP: Watch the sexual history video again and identify how the doctor responds to the patient’s cues, and what language she uses to probe, reassure, justify and acknowledge.