MMI Example Scenario – Communication skills

Angry Parent A&E

Imagine you’re a doctor and a parent brings their child into A&E. The current waiting time is more than an hour, and they are angry that the wait is so long. How do you deal with this situation?

Background: This is a very common situation – the NHS has a maximum waiting time of 4 hours across all hospitals’ A&E departments, with higher caseloads during the summer where cuts and sprains are seen very frequently. Previously there was a target wherein 95% of patients attending A&E should be seen within four hours, which was replaced by performance trajectories, with the percentage achieved dropping year on year on average. For reference, the current median wait time is around 150 minutes when both admitted and non-admitted patients are considered as of January 2017.

Even for those of us who do not have children, it’s easy to understand why any parent would be upset. Their most pressing concern is for their child, who is likely to be suffering if they have been brought to A&E, and may feel helpless or frustrated. There may also be other factors stressing them, such as needing to be at work on time or having other children to look after at home.

Firstly, it’s extremely important to demonstrate to the parent that you understand their anger. NHS wait times are very long at peak times, and these periods will feel even longer for stressed parents and especially their children. A good way to approach this is the ICE system, taught at many medical schools to ensure that the perspectives of the individual are heard.

ICE stands for Ideas, Concerns and Expectations. ‘Ideas’ refers to the beliefs they might hold, in this case the reason why they think the wait might be taking so long. A little more obvious, ‘Concerns’ is more about the particular thing that is worrying them – which will usually be one of the reasons we mentioned before. Lastly, Expectations is simply the course of action that they think would be best. Of course, you may not be able to comply with these, but the ICE system at least allows the parent a good opportunity to talk directly to you about the situation.

In general, be polite and courteous, as you should in any professional situation. You should be able to show empathy and be understanding, aiming to reassure any concerns they identify and working to their expectations as well as you are able. Explain that their child will be seen as quickly as possible and that all the staff are doing everything they can.

Ollie Burton, Postgraduate Lead @becomingadr


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Elliot is a St George’s graduate currently working as an F1 Doctor in East London. As the first in his family to apply to university, Elliot is well aware of the barriers that can be faced in trying to get to medical school. He is passionate about widening access to medicine for underrepresented groups.
 He was the representative for St George’s on the BMA Medical Students Committee, and has done lots of work with local schools and colleges to raise awareness of medicine as a career, as well as working on admissions policies with the widening participation team St George’s. Elliot is part of the @BecomingaDr outreach team and National Health Careers Conference Team.