Box 1. What’s in a good explanation?
  • Signposting and metacommunication (for example, indicating what the explanation is going to be about)

  • Definitions and causality (using lay terminology and phrases such as ‘which is/means/what it does/it can cause …’)

  • Narrative structuring (logical structure to the explanation, as if ‘telling a story’, but also inviting interpretation, or expression of meaning for the patient)

  • Repetition (can act as a scaffolding to give a list of symptoms, but also part of the rhythm and the way speech is patterned to make it easier to listen to)

  • Referential cohesion (linking one area of the explanation with other areas, with words like ‘it’ or ‘that’s’, but needs to be clear what is being referred to).

  • Metaphor (using everyday structures to explain medical terms; for example, a plumbing system to explain vascular problems)

  • Convergence and dialogue with patient (constantly checking you and the patient are aligned; for example, ‘what we call’/‘you’re right that’s what I mean/which are the things I was asking you about …’). A way of showing patient centredness even if you are doing most of the talking.