Key Takeaways
- A patient’s ideas, concerns and expectations should emerge through conversation rather than a rigid checklist.
- Use open, neutral questions and respond to the answers.
- Clarify expectations without implying that the patient is demanding a particular test or treatment.
- Do not ask all three questions consecutively using the same formula in every consultation.
Introduction
Exploring a patient’s ideas, concerns and expectations is a central part of patient-centred clinical communication. It helps you understand what the patient thinks is happening, what may be worrying them and what they hope to gain from the consultation.
However, these questions can sound unnatural when asked mechanically:
“What are your ideas?”
“What are your concerns?”
“What are your expectations?”
Patients do not usually describe their experiences using this language. Some may not understand what you mean, while others may feel that they are being taken through a memorised template.
The aim is not simply to complete an “ICE” checklist. It is to understand the patient’s perspective and use that information to guide the consultation. This is one reason why good English isn’t the same as good clinical communication.
Why Do Ideas, Concerns and Expectations Matter?
Two patients with the same symptom may arrive with very different priorities. One may believe that stress is the cause. Another may fear cancer because a relative was recently diagnosed. A third may mainly want to know whether it is safe to return to work.
If you do not explore these differences, you may provide a clinically accurate explanation without addressing what matters most to the patient.
The General Medical Council’s guidance on decision making and consent states that medical professionals should explore patients’ needs, values, priorities, concerns and expectations. NICE guidance also recommends discussing healthcare decisions in the context of the individual’s life and what matters to them.
1. Asking About the Patient’s Ideas
The patient’s “ideas” are their thoughts about what may be causing the problem or what the symptoms might mean.
Rather than asking, “What are your ideas?”, try:
- “What do you think might be causing this?”
- “Have you had any thoughts about what might be going on?”
- “What do you make of these symptoms?”
- “Do you think anything may have triggered it?”
Not every patient will have a particular explanation. If the patient says, “I’m not sure,” accept the answer and continue. Do not make them feel that they should be able to suggest a diagnosis.
You could respond:
“That’s absolutely fine. I just wanted to understand whether you had anything particular in mind.”
2. Asking About the Patient’s Concerns
Patients do not always reveal their main worry spontaneously. It may appear indirectly through repeated questions or hesitation.
Natural questions include:
- “Is there anything in particular you’re worried this might be?”
- “What is worrying you most about this?”
- “You seem worried. Would you like to tell me what is on your mind?”
- “Some people worry that symptoms like these could mean something serious. Is that something you’ve been thinking about?”
The final example can be useful when a patient appears reluctant to name a serious fear. However, avoid leading questions such as:
“You’re not worried about cancer, are you?”
This may discourage an honest answer.
When a patient reveals a concern, acknowledge it before moving to your next clinical question. A brief response such as “I can understand why that would worry you” can help build rapport with patients and show that you have listened.
3. Asking About the Patient’s Expectations
Expectations refer to what the patient hopes will happen during or after the consultation. The patient may want an explanation, reassurance, symptom relief, a referral or a particular investigation.
Avoid asking:
“What do you expect me to do?”
This can sound defensive or confrontational.
More natural alternatives include:
- “What were you hoping we might be able to help with today?”
- “Was there anything in particular you hoped we could do?”
- “What would be most helpful for you today?”
- “Were you hoping for any particular treatment or investigation?”
Asking about expectations does not mean agreeing to every request. It gives you an opportunity to understand the reason behind it.
For example, if a patient requests a scan, you could ask:
“Can I ask what you were hoping the scan might show or rule out?”
You can then address the underlying concern and explain medical conditions in plain English, including why a requested investigation may or may not be appropriate.
4. Do Not Ask All Three Questions at Once
A consultation can sound rehearsed if you ask about ideas, concerns and expectations consecutively.
Instead, introduce each question when it fits naturally:
- Explore the patient’s ideas after hearing the history of the problem.
- Ask about concerns when the patient mentions a fear or shows anxiety.
- Clarify expectations before discussing investigations, treatment or the management plan.
You may discover the answers without asking three separate questions. For example:
“I’ve been worried because my father had bowel cancer, and I was hoping you could arrange some tests.”
This single statement reveals both the patient’s concern and expectation. Your role is to recognise and respond to the information rather than ask questions that the patient has already answered.
5. Respond to the Answer—Do Not Just Record It
The value of these questions depends on how you respond. A simple structure is:
- Acknowledge: “I can see why that has been worrying you.”
- Clarify: “What is it about this symptom that made you think of cancer?”
- Address: “Let me explain what we know so far and what I recommend next.”
If the patient’s expectation cannot be met, explain your reasoning respectfully:
“I understand that you were hoping for antibiotics. Based on what you’ve told me and what I found during the examination, I don’t think they would help in this situation. Could I explain why and discuss what we can do instead?”
This acknowledges the request without dismissing the patient or promising inappropriate treatment.
Short Model Conversation
Doctor: “You’ve mentioned that you’ve had this cough for three weeks. Have you had any thoughts about what might be causing it?”
Patient: “I thought it was an infection, but my father had lung cancer.”
Doctor: “I’m sorry to hear that. Are you worried that your cough could be caused by cancer too?”
Patient: “Yes. I was hoping I could have a chest X-ray.”
Doctor: “I can understand why that has been on your mind. I’d like to ask a few more questions and examine you first. Then I can explain what I think may be happening and whether a chest X-ray would be helpful.”
The doctor explores the patient’s idea, identifies the underlying concern and clarifies the expectation. Importantly, the doctor neither dismisses the fear nor promises the requested investigation before completing the clinical assessment.
Common Mistakes to Avoid
Try not to:
- Ask about ideas, concerns and expectations as three disconnected checklist questions
- Interrupt before the patient has explained their answer
- Ignore cues that suggest an unspoken worry
- Use leading questions that encourage the patient to say “no”
- Dismiss an expectation without exploring the reason behind it
- Offer reassurance before completing an appropriate clinical assessment
- Ask about a concern and then immediately change the subject
Final Thoughts
Asking about a patient’s ideas, concerns and expectations should feel like part of a genuine clinical conversation, not an examination technique.
Listen for clues, choose questions that fit the moment and respond to what the patient tells you. Sometimes one open question will reveal all three areas.
With practice, this approach will help you sound more natural when speaking to patients while ensuring that important fears, beliefs and expectations are not overlooked.
If you would like to develop more confident, patient-centred consultation skills, book a consultation to discuss your goals and see how I can help.
References
General Medical Council (GMC) (2020, updated 2024) Decision making and consent. Available at: https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent (Accessed: 11 August 2026).
National Institute for Health and Care Excellence (NICE) (2021) Shared decision making (NG197). Available at: https://www.nice.org.uk/guidance/ng197 (Accessed: 11 August 2026).