The SCA Phrase Bank: What to Say in Each Part of the Consultation

The opening minute sets the agenda and, done well, saves you time for the rest of the case, because patients who feel heard early stop holding their real concern back for minute 9.

Open wide and then stay quiet: "What can I do for you today?" or "Tell me what’s been happening." The discipline is the silence afterwards. If the patient pauses, resist filling it; "go on" or simply nodding buys you the second half of their story, which is usually the half that matters.

When the notes give you context, use it visibly, because making effective use of existing information is explicitly part of the data gathering standard: "I can see you spoke to my colleague last week about your chest. How have things been since then?" That one sentence shows the examiner you read the brief and tells the patient they are not starting from zero.

And when the patient opens with several problems at once, negotiate rather than absorb: "You’ve mentioned your knee, your sleep and the medication. We may not do justice to all 3 today, so which is troubling you most? Then let’s see what we can do about the others." That is prioritisation, which the data gathering standard rewards when problems are multiple.

Every candidate knows to explore the patient’s perspective. The marks are lost in the how, because "do you have any ideas, concerns or expectations" announces the checklist and kills the conversation. Spread the exploration through the consultation and vary the wording.

For ideas: "What’s your own sense of what might be going on?" or "Have you had any thoughts yourself about what’s causing this?" For concerns, go a layer deeper than the symptom: "Is there anything in particular that’s been worrying you about it?" For expectations: "What were you hoping we might do about it today?" or "Was there something specific you had in mind when you booked in?"

The mark winning move is not asking these questions. It is using the answers, which the Relating to Others standard describes as tailoring your explanation and plan to the patient’s beliefs and preferences. So when the worry surfaces, name it and carry it forward: "So the real fear is that this is what your father had. Let me keep that in mind as we go, and I’ll come back to it directly when we talk about what I think is happening."

Cues are the small verbal and non verbal flags patients drop, and missing them is one of the most common communication criticisms in the exam’s own feedback statements. The response does not need to be elaborate. It needs to exist, and quickly.

For a verbal cue: "You said work has been a lot lately. Tell me a bit more about that." For an emotional one: "You sound quite low when you talk about this." For a visible one on video: "I noticed your face changed when I mentioned the hospital. What was that about?" And when a cue arrives mid flow and you cannot follow it immediately, park it out loud rather than dropping it: "I want to come back to what you just said about your sleep. Let me ask 2 quick things first and then we will."

Brief summaries and signposts are the cheapest marks in the consultation: they demonstrate active listening, keep your structure visible, and routinely prompt the patient to correct or add something important.

Summarise in one or two sentences, then check: "So, 3 weeks of a dry cough, worse at night, no blood, and you’re mostly worried because your neighbour was recently diagnosed with something serious. Have I got that right?" Signpost when you change gear: "I’d like to ask some more pointed questions now, including a couple that might sound alarming. They’re routine, and they help me make sure we’re not missing anything." That single line makes your red flag screen feel like safety rather than interrogation, which serves both data gathering and the relationship at once.

Candidates lose more marks in the transition than almost anywhere else, drifting on with history until the time for management has gone. Make the switch deliberate and audible, and share your reasoning as you make it, because the diagnosis standard rewards thinking the examiner can actually hear.

"Thank you, that gives me a clear picture. Let me tell you what I think is going on." Then reason out loud, in plain words: "Putting it together, the pattern fits acid reflux rather than anything to do with your heart, and here’s why I say that." If genuine uncertainty remains, own it rather than hiding it, because managing uncertainty is explicitly part of the standard: "I’ll be honest that it’s not completely clear cut yet. The most likely explanation is X, and the safe way to handle the uncertainty is to do Y and review you."

The management standard rewards plans negotiated with the patient, not announced at them. The phrasings are simple and the habit is everything.

Offer genuine options: "There are a couple of reasonable ways we could approach this. We could start with X, or we could try Y first. Let me explain the difference, and then I’d like to know which sits better with you." Fold their stated preferences back in: "Given you said you’d rather avoid tablets if possible, the option I’d lean towards for you is this." And invite pushback before closing: "How does that plan sound? Is there anything about it that doesn’t work for your situation?"

When the patient wants something you do not think is right, the standard asks you to challenge unhelpful beliefs while keeping the relationship, so disagree with the request, not the person: "I can hear how much you want the antibiotics, and I understand why. Let me explain why I don’t think they’d help here, and what I think will, and then let’s talk it through."

Explanations score when they are jargon free, sized to the person, and checked. Anchor them to what the patient already told you: "You mentioned you thought this might be your heart. It’s good news on that front, and let me explain what I think it actually is." Chunk rather than lecture: 2 or 3 sentences, then "does that make sense so far?" And check understanding without patronising by putting the burden on yourself: "I’ve thrown a lot at you. Just so I know I’ve explained it properly, can you tell me what you’ll take away about what we’re doing next?"

The exam’s feedback statements single out safety netting that is missing, vague or disproportionate. The fix is specificity in 3 parts: what to watch for, over what timescale, and what to do about it.

"If the pain spreads to your arm or jaw, or you become breathless or sweaty with it, that’s a 999 call, straight away, not a wait for us." For the routine version: "I’d expect this to be settling within 2 weeks. If it’s not improving by then, or it gets worse at any point, I want you back in, and if you notice blood at any stage, come back sooner." Then make the follow up concrete rather than ornamental: "Let’s book the review now for 2 weeks, so it’s in the diary either way."

Proportion matters as much as presence. A heavy safety net on a trivial problem reads as anxiety, not safety, which is exactly the over correction trap the College warns re-sitting candidates about in Failed the MRCGP SCA: How to Pass Your Re-sit.

Warn before you land it: "I’m afraid the results aren’t what we were hoping for." Then deliver it clearly, without euphemism, and stop. The silence that follows is the consultation working, not failing, and the next line belongs to the emotion rather than the plan: "I can see this has knocked you. Take a moment." When you do move forward, hand over the pacing: "Would it help if I explained what happens next, or would you rather have a minute first? People want different things at this point and there’s no wrong answer."

For anger, the same principle of emotion before content applies, and the de-escalating move is to name it without defending: "I can hear how frustrated you are, and honestly, in your position I might feel the same. Help me understand what’s made this worse, and let’s see what we can sort out today." Agreement with the feeling costs you nothing and is usually the turn in the consultation. The fuller method for these cases is in Challenging SCA Consultations.

When the clock is closing in, close deliberately rather than trailing off: "We’re nearly out of time, so let me pull this together. Here’s what we think is going on, here’s what we’re doing about it, here’s when I’m seeing you again, and here’s what should bring you back sooner. Before we stop, what would you most like me to clarify?"

A phrase you have read once will not be there at minute 9 of a real case. A phrase you have used thirty times will. So pick a handful from each section that sound like you, write your own variants, and then run them inside timed practice cases with a partner whose job is to drop cues, push back and tell you which lines landed as human and which landed as performed. The method for that practice is in How to Practise SCA Cases With a Study Partner, and if you need cases to run it with, our free library of 79 SCA practice cases built from the RCGP curriculum, each with a patient script written to give your partner exactly those cues, is open to you whenever it helps.