I thank Dr Matthys for his thoughtful and constructive response.1 It is comforting to know that other experienced colleagues face similar challenges in encouraging young GPs towards a more patient-centred consulting style. Heaven knows, we need to; I remember once being told by a candidate in an oral exam, ‘Of course, I’d ICE the patient and all that rubbish’!
My personal experience in teaching trainees and MRCGP candidates about receipts has been that young doctors in particular appreciate and readily master this technique for getting beneath the surface of the patient’s agenda early in the consultation. ‘We know we ought to,’ they often tell me, ‘but we didn’t know how.’ I think providing them, early in their consulting lives, with a tool which helps the patient’s thoughts to emerge naturally from the conversation is preferable to prolonging the habit of closed questioning, albeit in a two-tailed ‘Do you think A or B?’ format.
As to whether we need more ICE research, there’s a whiff of irony about asking the question, ‘Is it good to ask questions?’ What matters is not whether the doctor utters words which could be classified as enquiries about I, C, or E, but rather whether the patient’s inner world is explored sensitively and relevantly, and whether the doctor knows what to do with the information gleaned. Research in this area, I suggest, should not be just an ‘arm’s length’ affair of randomised trials or Likert scales. Rather, it needs to be participative person-centred research of the type championed by, for example, Peter Reason.2
- © British Journal of General Practice 2014
