Understanding and Using ICE in Medical Practice
- Ann Augustin
- Jul 26
- 3 min read
Updated: Aug 24
Empathy meets clinical efficiency in the consultation room.
What is ICE?
In medical consultations, especially in general practice and OSCE-style examinations like PLAB 2, ICE stands for:
Ideas – What does the patient think is going on?
Concerns – What is the patient worried about?
Expectations – What is the patient hoping to gain from the consultation?
This simple framework helps clinicians delve into the patient’s perspective, allowing not only for better rapport but also for targeted, patient-centred care.
Why is ICE Important?
When patients seek medical help, it’s rarely just about a symptom. It’s about how that symptom affects their life, their fears about what it could mean, and what kind of help they believe they need.
❝ A patient doesn't come to the GP simply because they have a symptom. They come because that symptom is affecting their life or worrying them in some way. ❞
Ignoring this perspective can lead to:
Miscommunication
Missed concerns
Patient dissatisfaction
Poor compliance with treatment
ICE bridges the gap between clinical knowledge and the human experience of illness.
When to Use ICE?
ICE is ideally used:
After gathering basic clinical information using frameworks like SOCRATES or the Calgary-Cambridge model.
Before or after PMH/FH/SH, depending on the flow of the consultation.
Always in any scenario involving uncertainty, emotional distress, or expectations of treatment (e.g. insomnia, headache, contraception requests).
Think of ICE as the lens through which you see the patient's narrative, after forming your own working diagnosis.
Breaking Down ICE: Examples & Clinical Application
🧠 Ideas
Ask:
“Do you have any thoughts on what might be causing this?”
“Have you read anything or looked it up?”
Why it's important:
Helps identify misconceptions.
Reveals how much the patient already knows.
Shapes how you explain the diagnosis and correct fears gently.
📍 Example:A patient with a tension headache says, "I’m worried this could be a brain tumour."—> This directs you to rule out red flags and reassure based on your clinical findings.
💬 Concerns
Ask:
“Is there anything in particular that’s worrying you about this?”
“How is this affecting your day-to-day life?”
Why it's important:
Allows you to see the emotional burden of the illness.
Informs your management plan, e.g., offering time off work, mental health support, or reassurance.
📍 Example:A patient says, “I’m scared I might faint again and embarrass myself at work.”—> Tailor safety netting, discuss triggers, and empower the patient with strategies.
🎯 Expectations
Ask:
“What were you hoping I could do for you today?”
“Were you expecting any tests or treatment?”
Why it matters:
Aligns your clinical plan with their hopes.
Prevents unmet expectations or conflict.
Clarifies if the request is appropriate (e.g., a request for sleeping pills vs. a need for behavioural therapy).
📍 Example:A patient says, “I was hoping you’d give me some sleeping pills like my mum’s.”—> You can then explain safer options like sleep hygiene and why medication may not be suitable.
Using ICE in Real Practice: A Flow
Gather the basic clinical story using SOCRATES and history taking.
Pause and shift the focus to the patient: "Can I ask—what are your thoughts on what this could be?"
Follow with concerns: "Is there anything in particular that's been worrying you?"
Then expectations: "What were you hoping we could do for you today?"
This allows a natural flow that combines medical reasoning with empathy.
When ICE Reveals Something More
Sometimes, ICE questions may uncover:
Psychosocial issues (e.g., anxiety about job security due to illness)
Safeguarding concerns (e.g., young patients requesting contraception)
Hidden agendas (e.g., requests for specific medications not clinically indicated)
Rather than being a tick-box tool, ICE is a gateway to holistic care.
Final Thoughts
Using ICE is not about prolonging consultations or being overly sympathetic—it's about being clinically effective and compassionately efficient. By understanding a patient's ideas, concerns, and expectations, you become not just a diagnostician, but a trusted guide through their health journey.
🩺 The best doctors don’t just treat symptoms—they understand stories.
Quick Recap
Component | Purpose | Example Question |
Ideas | Understand patient's thoughts | "What do you think might be causing this?" |
Concerns | Identify fears or worries | "Is there anything in particular you're worried about?" |
Expectations | Align care with hopes or needs | "What were you hoping I could do for you today?" |
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