How to Explain Results and Diagnoses in the SCA

Why Results Cases Appear So Often in the SCA

Explaining results is one of the most common tasks in general practice. GPs deliver blood test results, imaging findings, screening outcomes, and new diagnoses every day. The SCA reflects this by including results consultations in most exam diets.

These cases test something that textbook preparation does not develop: the ability to communicate clinical information to a non-clinical person in a way that is clear, empathetic, and actionable. You may understand what a DEXA T-score of minus 2.7 means, but can you explain it to a 65-year-old patient who has never heard the word osteoporosis in a way that informs without alarming?

Results cases also test adaptability. The same result delivered to different patients requires different approaches. A fatty liver finding in a patient who already suspects lifestyle factors need discussion lands differently from the same finding in a patient who had no idea anything was wrong. The clinical content is identical. The consultation skill is not.

MedTutor's data shows that explaining results cases have moderate difficulty ratings but high feedback request rates, suggesting trainees feel less confident about how they communicated the result than whether they knew the clinical content.

Check Before You Tell: What Does the Patient Expect?

This is the single most important habit in results consultations: before you deliver the result, find out what the patient is expecting.

"Before I share the results with you, can you tell me what you were hoping to hear?" or "What have you been thinking about while waiting for these results?"

This 30-second question transforms the consultation. It tells you the patient's emotional starting point. If they are expecting bad news and you deliver good news, the relief is palpable and you can build on it. If they are expecting good news and you deliver bad news, you know you need a warning shot and careful pacing.

It also gives you data for the examiner. Checking expectations demonstrates Data Gathering (you assessed the patient's understanding), Relating to Others (you considered their emotional state before delivering information), and sets up Clinical Management (you can tailor your explanation to their level of understanding).

What happens when you skip this step: you deliver a result into a vacuum. You do not know whether the patient is terrified, relaxed, confused, or resigned. Your explanation is generic rather than tailored. The examiner notes that you delivered information without first understanding the recipient.

Three Types of Results Consultations

Not all results consultations are the same. Recognising which type you are dealing with helps you structure the consultation appropriately.

Type 1: Normal results that need context. The result is normal, but the patient needs to understand what it rules out, what it does not rule out, and what happens next. These consultations are deceptively simple. The temptation is to say "Everything's fine" and move on, but the patient may have specific questions about what was tested and why, or they may still have symptoms that the normal result does not explain.

Type 2: Abnormal results requiring action. The result shows something that needs treatment, monitoring, or lifestyle change. Fatty liver, osteoporosis, elevated cholesterol, abnormal semen analysis. These are not life-threatening diagnoses, but they change the patient's understanding of their health and often require ongoing management. The consultation challenge is explaining the finding, its implications, and the plan without overwhelming the patient.

Type 3: Results that indicate a new chronic diagnosis. Type 2 diabetes, familial hypercholesterolaemia, or results that confirm a condition the patient will live with permanently. These are the most emotionally significant results consultations and require more time for the patient to process, ask questions, and begin to understand what the diagnosis means for their life. These overlap with breaking bad news but are distinct because the emotional register is different: concern and adjustment rather than shock and grief.

Normal Results That Need Context

A normal result does not always mean a straightforward consultation. The patient may have been anxiously waiting for weeks. They may still have symptoms that the normal result does not explain. They may not understand what was tested or what "normal" actually means.

The structure for a normal result consultation:

Check expectations first. "What were you hoping to hear?" If the patient was worried about cancer and the result is normal, the relief is the emotional centre of the consultation. Acknowledge it.

Explain what was tested and what the result means. "We tested your blood for thyroid function and iron levels, and both are in the normal range. That means those two common causes of fatigue have been ruled out." Be specific about what was tested. "Your bloods are fine" is vague and does not help the patient understand their health.

Address what the normal result does not explain. If the patient still has symptoms, acknowledge that the normal result is useful (it rules things out) but it does not mean you are dismissing their symptoms. "The good news is that we've ruled out some important causes. The fact that you're still feeling tired means we should look at other explanations, and I'd like to discuss those with you."

Plan next steps. A normal result without a plan leaves the patient in limbo. Either the case is closed (with safety-netting), or further investigation is needed, or lifestyle factors should be discussed. The examiner wants to see a clear next step.

Abnormal Results Requiring Action

Abnormal results that are not life-threatening but require action form the bulk of results consultations in both the SCA and real practice. Fatty liver, osteoporosis, raised cholesterol, abnormal semen parameters, mildly elevated HbA1c.

The consultation challenge is calibrating the emotional register correctly. These are not breaking bad news cases. The patient does not need a warning shot and an extended emotional processing period. But they are not "everything is fine" cases either. The patient is learning something new about their body that may require treatment, lifestyle change, or ongoing monitoring.

The structure for an abnormal result:

Deliver the result clearly in plain language. "Your liver scan shows some fatty changes. This means your liver is storing more fat than it should be." Not: "You have NAFLD grade 2."

Explain the significance without catastrophising. "This is common and it is reversible, but if we leave it, it can lead to problems with your liver over time. So it is worth addressing now." This calibrates the concern: it is important enough to act on, not serious enough to panic about.

Discuss the management plan collaboratively. "There are a few things we can do. The most effective is lifestyle changes: reducing alcohol, improving diet, and increasing activity. I'd like to discuss what feels realistic for you." Shared decision-making is essential here. The examiner is watching whether you impose a plan or build one together. See our story-led consulting guide for how to make this collaborative rather than prescriptive.

Arrange follow-up. "I'd like to repeat the scan in 6 months to see if the changes are improving. We can also check your liver function with a blood test before then." Follow-up demonstrates continuity of care and gives the patient a concrete next step.

Practise this with Explaining Fatty Liver Scan Results, where the patient may not have expected an abnormal finding, and DEXA Scan Results: Osteoporosis, where the patient is learning about a condition they may associate with frailty and ageing.

The New Diagnosis Conversation

A new chronic diagnosis is the most emotionally significant results consultation. The patient is learning that they have a condition that will affect their life permanently: type 2 diabetes, familial hypercholesterolaemia, rheumatoid arthritis.

This overlaps with breaking bad news but is distinct. Breaking bad news cases typically involve a potentially life-limiting diagnosis (cancer, terminal illness) where the emotional register is shock and grief. New chronic diagnosis cases involve a life-changing but manageable condition where the emotional register is concern, adjustment, and sometimes denial.

The key principles:

Give the diagnosis clearly and early. Do not bury the diagnosis in a long preamble. "Your blood test shows that your blood sugar levels are in the range for type 2 diabetes." Then pause. Let the patient absorb it.

Check their reaction before continuing. "What does that mean to you?" or "How are you feeling about hearing that?" The patient's response determines your next move. If they are shocked, slow down and provide emotional support. If they are matter-of-fact ("I suspected as much"), you can move to the management plan more quickly.

Do not try to cover everything. A new diagnosis of type 2 diabetes involves medication, diet, exercise, monitoring, complications, driving regulations, travel insurance, and more. You cannot cover all of this in 12 minutes and you should not try. Cover the essentials: what it is, what we do first, and when we meet again to discuss more. "There's a lot to cover and I don't want to overwhelm you today. Let's focus on the most important next steps and I'll book you in for a longer appointment next week where we can go through everything in detail."

Practise this with New Diagnosis of Type 2 Diabetes, which tests whether you can deliver the diagnosis, address the patient's immediate reaction, and create a manageable plan without the information dump time trap.

Language, Jargon, and Pacing

The way you deliver results matters as much as the clinical content. Three principles:

Remove jargon. Every medical term you use creates a comprehension gap. "Your T-score is minus 2.7, which meets the diagnostic criteria for osteoporosis" contains three pieces of jargon. "Your bone density scan shows that your bones are thinner than we'd expect for your age, which means they're more likely to break" contains none. The clinical content is the same. The patient's understanding is completely different.

This does not mean dumbing down. It means translating. You can be clinically precise without using clinical language. The examiner will note whether the patient understood your explanation, and jargon-heavy explanations consistently lose Relating to Others marks.

Pace your delivery. Do not deliver the result and the entire management plan in one breath. The result is one piece of information. Pause. Check understanding. The implications are a second piece. Pause. Check again. The plan is a third piece. This pacing prevents information overload and gives the patient space to process, ask questions, and engage.

Use the "chunk and check" method. Deliver information in small chunks, then check understanding before moving to the next chunk. "Your scan shows some fatty changes in your liver. Do you know what that means?" Adjust your next chunk based on their response. If they say "Is it serious?" you address that question before continuing with the management plan.

Match your tone to the result. A normal result can be delivered with warmth and mild reassurance. An abnormal result needs a measured, calm tone that conveys seriousness without alarm. A new diagnosis needs space and patience. Matching your energy to the situation is one of the principles from our story-led consulting guide.

Common Mistakes in Results Consultations

Mistake 1: Delivering the result without checking expectations. This is the most common error and the most easily fixed. Thirty seconds at the start of the consultation ("What were you expecting?") transforms the rest of the conversation.

Mistake 2: Using jargon. "Your eGFR is 58" means nothing to most patients. "Your kidney function is slightly lower than normal" means something. Every piece of jargon you use is a missed opportunity for clarity.

Mistake 3: The information dump. Delivering the result, diagnosis, management plan, lifestyle advice, medication options, follow-up schedule, and safety-netting in one continuous monologue. The patient retains almost nothing. Chunk and check.

Mistake 4: Not addressing the emotional dimension. An abnormal result is not just a clinical finding. It is news that changes how a patient thinks about their body. Even a relatively minor finding (fatty liver, borderline cholesterol) can trigger anxiety, denial, or guilt. Acknowledge the emotional response before moving to the management plan.

Mistake 5: Failing to arrange follow-up. A result without a next step leaves the patient in limbo. Even if the result is normal, tell the patient what happens next: "No further tests needed, but if symptoms continue, come back in 4 weeks." For abnormal results, clear follow-up is essential: when, what will be checked, and what the patient should do in the meantime.